[Indigestion in cattle due to partial or total obstruction of the gastrointestinal tract (author's transl)]

The clinical picture and the results of examination and treatment in a cow with "posterior stenosis" are reported. The metabolic effects resulting from obstruction of the gastrointestinal tract and reflux of the contents of the abomasum are then discussed. The classification into "anterior" and "posterior" stenosis is of importance in the differential diagnosis. The most common cause is local peritonitis originating from traumatic reticulitis or abomasal ulcer. Treatment of "posterior stenosis" is mainly directed to removing the cause, though restoring water and salt metabolism and the acid-base equilibrium also are of major importance.

Neo-Mull-Soy metabolic alkalosis: a model of Bartter's syndrome?

A case of Neo-Mull-Soy-induced metabolic alkalosis occurred in an 8-month-old child. This child had hypochloremic hypokalemic alkalosis as well as hyperreninemia. Initially, a diagnosis of Bartter's syndrome was made and treatment consisted of KCl replacement, indomethacin, and aspirin. In retrospect, the diagnosis of Neo-Mull-Soy induced metabolic alkalosis could have been suspected on the basis of the low chloride concentration in his urine. Proposed mechanisms for the etiology of Bartter's syndrome are reviewed. Neo-Mull-Soy induced metabolic alkalosis simulates Bartter's syndrome and supports the concept that the primary abnormality in Bartter's syndrome is chloride deficiency. The chloride deficiency in Bartter's syndrome results from a defect in active chloride transport in the thick ascending limb of the loop of Henle.

The dietary chloride deficiency syndrome

Chronic depletion of body chloride developed in a group of infants ingesting a diet consisting almost exclusively of chloride deficient Neo-Mull-Soy. Ten of the 12 infants were on this diet three to five months before loss of appetite, failure to thrive, muscle weakness, and lethargy led to a diagnostic evaluation. The outstanding laboratory features were severe hypokalemic metabolic alkalosis, low urinary chloride concentrations (< 10 mEq/liter), and erythrocyturia. There was marked decrease in weight for age in all 12 infants. Head circumference for age had decreased in five of six and length for age in five of ten infants for whom earlier measurements were available. The biochemical abnormalities reverted to normal following dietary supplementation with either sodium or potassium chloride. Appetite, affect, and muscle strength improved, and weight gain resumed. Head circumference for age has moved toward the percentile level present prior to starting Neo-Mull-Soy in all instances. With one exception, length measurements show a similar pattern. The erythrocyturia has decreased or vanished. Chloride deficiency led to contraction of the extracellular volume and the substitution of poorly reabsorbable anions for readily reabsorbable chloride. These alterations caused development of the negative hydrogen ion and potassium balances which led to the hypokalemic metabolic alkalosis.

Treatment of undernutrition and electrolyte disturbances in anorexia nervosa

Medical care of undernutrition and hydro-electrolytic disturbances in anorexia-nervosa differs according to the stage of weight loss, as appreciates through "corpulence index". In each case, it will depend on a precise appreciation of biological data, mainly hydro-electrolytic ones. One has to particularly stress the frequence of hypochloremic-hypokalemic alkalosis which must be treated by isotonic saline perfusion till the normalisation of plasma electrolytes. Refeeding can be achieved either by oral, parenteral or nasogastric tube: this last method being, in our hand, the most successful. The results of short-term treatment is often good; however the prognosis of long term treatment largely depends on the specific care for psychological disturbances.

Carcinoid tumour of the thymus with Cushing's syndrome

A 29-yr-old male developed Cushing's syndrome with severe hypokalaemia, alkalosis and hypernatraemia. He died with Pseudomonas septicaemia and Nocardia pneumonia. At autopsy he was found to have a carcinoid tumour of the thymus which was not suspected before death, and marked bilateral hyperplasia of the adrenal cortex.

Hypochloremic alkalosis in infants associated with soy protein formula

Thirteen infants, 2 to 10 months of age, developed hypochloremic alkalosis (serum chloride 59 to 92 mEq/l) while taking Neo-Mull-Soy (Syntex), a soy-based formula low in chloride (measured to be 0 to 2 mEq/l) but with considerable potassium citrate. Range of symptoms included lethargy, anorexia, mild spitting up, diarrhea, hematuria, and growth failure. Urine chloride excretion was less than 3 mEq/l. Plasma renin activity or aldosterone, measured in six infants, was elevated. All responded promptly to supplemental salt. One infant receiving Neo-Mull-Soy redeveloped alkalosis when supplemental salt was discontinued. Two of nine apparently normal infants receiving Neo-Mull-Soy also had hypochloremia (85, 86 mEq/l). Three of four receiving Prosobee (Mead Johnson; Cl content 7 mEq/l) had urine chloride concentration less than 20 mEq/l. The chloride content of some infant formulas is insufficient to offset salt losses following mild stress.

Failure to thrive and metabolic alkalosis. Adverse effects of a chloride-deficient formula in two infants

This report concerns two infants with failure to thrive and hypochloremic metabolic alkalosis. Both infants were fed exclusively with a soybean-based formula, which, as a result of a manufacturing error, was severely deficient in chloride. When an alternative formula containing an adequate amount of chloride was prescribed, the electrolyte abnormality was corrected, and the infants resumed their normal weight gain.

The use of intravenous hydrochloric acid in the treatment of thirty-four patients with metabolic alkalosis

Since 1972, 34 patients with refractory metabolic alkalosis have been treated with intravenous hydrochloric acid at the teaching hospitals of the Medical College of Georgia. Intravenous hydrochloric acid lacks some of the problems associated with alternative methods of therapy. The acid must always be given through a central vein, and its effects should be monitored closely. The use of intravenous hydrochloric acid is a safe, effective way of preventing the deleterious effcts of severe metabolic alkalosis.

Acid-base changes of mature and premature neonates following exchange transfusion

The changes of acid-base values of 60 mature and premature neonates treated by exchange transfusion were followed. It could be shown that the blood conserves having acidic pH values caused no acidosis if the acid-base balance of the patients had been normal before transfusion. An existing acidosis frequently increased significantly in the first day of life of the mature but also in the later days in premature neonates. Thus, the determination of acid-base state prior and after transfusion of such patients seems to be important. In the case of pronounced acidosis its correction and also the control of the acid-base values after the exchange transfusion are necessary.