Introduction to Fluid-Electrolyte Balance
As this story moves on, the importance of my interest in the
loss of body fluids and their correct replacement will grow to be
a major part of my work. And this direction really began on the
ward in Boston during my research months. I was passing through the
surgical wad and noticed a swollen jaundiced postoperative patient,
comatose and obviously in deep trouble. I asked the resident about the problem.
He said that the patient, a medical school student’s father. And he was dying
of liver failure, as evidenced by the jaundice and a serum albumin of 3 gm.%,
just 1/2 of normal, this presumed to be the cause of of the edema. All attempts
to save him were failing, particularly as he couldn’t keep anything down. This
was in the days were hyper-alimentation wasn’t even a dreams. I asked if I
might try to help.
It was then that the process I was to develop in dealing with
such problems may have surfaced. I found myself asking “What
is the Real Problem, not the Apparent Problem”?
To get started, I measured everything I could. The flame photometer was as yet
not available but I could easily measure the serum and urine chlorides in the
lab. And I found the serum chloride too high and the urine chloride also high.
It seemed likely that he was being overloaded with salt, and that the kidney
could not keep up with the excess as it tried desparately to remove it.
There
was no data on urinary electrolytes at that time, but Thomas Addis had made
it clear that the kidney is a reasonable osmotic organ. Its messages could be
understood if one accepted that its primary function other than the excretion
of end-products of metabolism was to maintain water and salt in balance.
Thus, my common sense said that the edema and low serum
protein could be explained if all of the tissue were being flooded
to the point that swollen liver cells could not function well.
They then would not be able to maintain normal serum protein
concentrations. Jaundice was consistent with the same cellular
failure. Scales to weigh the excess body fluids would not appear
for another seven years when I would provide it. So the amount of excess fluid
retention still had to be just a clinical impression, and must have amounted
to more than 20 pounds.
I examined the intravenous record. It was obvious that as
the patient failed, aggressive administration of 0.9% saline
solution (9 grams of salt per liter) might be the problem. No one
interfered when I stopped the IVs, with the intent to “dry him out”.
Over some five days we watched the edema and jaundice disappear. His serum protein
returned to a normal 6 without any protein intake. He began to eat. He went home
five days later.
So, what had happened that made this recovery possible?
-
The built in logic of the engineer in his search for “The
Problem” based on “Process” and an unwillingness to be
guided by “impressions”.
-
A unique tutelage by Thomas Addis as he pioneered the
concept that the kidney is an osmotic organ to be understood
and listened to.
-
An analytical turn of mind beginning to come to terms
with the then revolutionary concept of weight and water, a scale
to monitor body water still in the future.
Next page: Discovery #2 (1947): Thrombophlebitis and Pulmonary Embolism Prevention
Introduction
Gifts from Inheritance
Gifts from Inheritance, page 2
Gifts from Inheritance, page 3
The Open Mind
The Transition..? Metamorphosis.
The Process of Getting There
1947....Discovery #1....A Beginning
Discovery #2 (1947): Thrombophlebitis and Pulmonary Embolism Prevention