ACID-BASE EQUILIBRIUM AFTER INTESTINAL URINARY DIVERSION

Abstract

Acid-base equilibrium and renal function were observed on the cases of ureterosigmoidostomy, sigmoidocutaneus ureterostomy (transplantation of one ureter to sigmoid colon and one ureter to skin), ileocystoplasty, uretero-ileo-cystoneostomy, and some other conditions. The studies of sigmoidal absorption of urine and ammonium chloride solutions were made on the dogs, and possible causes for electrolyte imbalance were discussed.
1) The development of hyperchloremic acidosis was related both to the types of operation and the renal function.
2) Polyuria and low urine electrolyte concentrations were usually obsurved in the cases of ileocystoplasty and ureterostomy in acidosis. The urine of such cases showed an impaired ability to excrete hydrogen ions and ammonia and to reabsorb bicarbonate.
3) In the cases of ileocystoplasty the ileal urine contained more sodium and bicarbonate, less pottasium, chloride and urea than the renal urine.
4) The instillation of hypotonic ammonium chloride solution into dog's sigmoid effected a decrease in blood chloride levels, while hypertonic ammonium chloide solution effected an increase.
5) In the cases of urinary diversions acidosis may occur when renal function is involved and the kidney is no longer able to eliminate acid loads to the body. The sites of involvement are mainly renal tubles, and the patients are in the tendency to be dehydrated on account of continuous loss of water and elecyrolytes. Reabsorption of urinary constituents and alkali loss from the bowel increase acid loads and accelerate dehydration. The high blood chloride levels would be due to a compensatory mechanism, whereby the total anion (hence cation) concentration is maintained relatively constant.
6) For the treatment of hyperchloremic acidosis sodium bicarbonate is remarkably effective.
7) The 3 year and 5 year survival rates of intestinal urinary diversions were 20.0 per cent and 9.1 per cent for ureterosigmoidostomy, 50.0 per cent and 37.5 per cent for sigmoidocutaneus ureterostomy, 66.7 per cent and 60.0 per cent for ileocystoplasty, and 80.0 per cent and 66.7 per cent for uretero-ileocystoneostomy. This order was actually the same as that of the incidence of hyperchloremic acidosis.