The chlorides of the plasma in uremia

Previous investigations relating to the chlorid content of the blood or plasma in uremia have yielded conflicting results, some figures much lower than the lowest normal limit having been reported. 2 It is known that the chlorid content of nephritic plasma is usually somewhat higher than that of the average normal plasma, but the findings in uremia have apparently so far not been explained.

We have been able, in several cases, to make frequent observations of the chlorid content of the plasma of nephritic individuals during life, and up to the time of death in uremic coma. We have found a diminution of chlorids in the plasma to be the usual accompaniment of uremia, and we have found this decrease of chlorids in the plasma to accompany the increased H + ion concentration frequently observed in the blood of uremic patients shortly before death.

That increased acidity of the blood causes a diminution of the plasma chlorids, and an increase in the chlorid content of the cells had been shown experimentally both in vitro and in vivo by Hamburger. 1 That a similar change occurs with the increased acidity of the blood in uremia is illustrated by the following case of nephritis, terminating in uremia.

Case 1. P. W. M., male, age 44, chronic interstitial nephritis, uremia. Patient admitted June 17, suffering with chronic interstitial nephritis, hypertension and secondary cardiac failure with edema. With rest in bed the heart condition rapidly improved and the edema disappeared. Following this the patient felt well and the condition remained stationary, until October 12, when an impending uremia first became manifest by an increase in the blood urea and a diminished urea excretion. From June 17 to October 6 there were made twenty blood analyses, with simultaneous urine analyses, and the results showed very slight variation.