PEDIATRICS Vol. 6 No. 2 August 1950, pp. 183-191
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USE OF PARENTERAL POTASSIUM THERAPY IN SURGICAL PATIENTS

Its Role in Preventing Chloride Loss

CHARLES UPTON LOWE M.D.1, MARGARET ROURKE 1, ELSIE MACLACHLAN B.S.1, and ALLAN M. BUTLER M.D.1

1 The Children's Medical Service of the Massachusetts General Hospital and the Department of Pediatrics, Harvard Medical School, Boston.

IT HAS been observed frequently that following surgery patients may have a low serum chloride concentration. The shocklike state which occasionally occurs has been assumed to be the result of this low serum Cl. Therapy as radical as parenteral use of dilute hydrochloride acid has been advocated. Animal experiments indicate that when there is a deficit of potassium and an excess of sodium within the cells, the concentration of Cl in the plasma decreases while that of HCO3 increases. With the ingestion of K there is a retention of Cl and rise in serum Cl. Such changes in tissue and serum concentration also occur in the hyperadrenalism of Cushing's syndrome and of the alarm reaction in rats. That such an alarm reaction may result from operations is indicated by a fall in circulating eosinophiles and an increase in urinary 11-oxycorticoids. Moreover, such starvation and parenteral saline as may be incident to operation favor these alterations in tissue and serum concentrations.

The following studies were undertaken to determine whether the use of parenteral K in surgical patients would increase the intracellular potassium concentration and prevent a loss of Cl from the body. The results augment the affirmative evidence that has been accumulating since these studies were made.

Plan of Study

Five patients with surgical disease were studied. Those patients that were chosen had no stools during the period of observation. Two infants, 21 mo. and 7 mo. of age, had intussusception. Three children had perforated appendices with peritonitis, two 9 yr. old and one 14. The 2 children (S.L. and A.B.), who were the same age and weight and had perforated appendices, were felt to be ideal subjects for comparison between the 2 types of therapy. Therefore, throughout periods of study one (S.L.) received Na, Cl and glucose, the other (A.B.) a similar regime to which K had been added.

Submitted on December 1, 1949