慢性腎不全における酸塩基平衡に関する臨床的研究

概要

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In order to study acid-base balance in chronic renal failure, the variations of the bicarbonate-carbonic acid buffer system, chloride, HPO_4^<-->, SO_4^<--> and potassium were analysed. The results obtained are as follows. Use of venous blood was useful clinically to determine blood pH and Pco_2. In chronic renal failure, reduction in pH was usually seen before respiratory disorder, such as Kussmaul's breathing, became evident. Such pH reduction was caused by insufficient decrease of Pco_2 comparing with HGO_3^-. HPO4〜〜 and SO_4^<--> had positive correlation with BUN, and when HPO_4^<--> and SO_4^<--> elevated, low HCO_3^- was observed. Therefore, if we consider acidosis as a major purpose for hemodialysis, elevation of BUN is a useful index to indicate hemodialysis. It was suggested that low blood HCO_3^- was not the direct result of elevation of HPO_4^<--> and SO_4^<-->. Hypochloremia in chronic renal failure is due mostly to the reduction in HCO_3^<-->, and hypoproteinemia accentuates it. Marked elevations of HPO_4^<--> and SO_4^<--> were observed in hypochloremia of chronic renal failure in our study. However, these elevations could not be so large in the patients, other factors are to be checked when severe hypochloremia is seen. Body potassium reduction was observed in terminal stage of chronic renal failure. Decrease in pH was found to influence blood potassium level if hyperkalemia was found in terminal stage.
千葉大学の論文