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The importance of the renal tubular Post Date: Sun, 12 Oct 2008 9:23:00 +0000
The reabsorption of organic as well as inorganic solutes by the renal tubule, although naively defined and unmeasured, had necessarily been invoked in all the proposed theories of renal function that included the formation of a glomerular filtrate. The development of technics for tubular micropuncture and accurate clearance measurements and the study of isolated renal tissue have now allowed detailed description of the functional characteristics of the transport of organic solutes out of, as well as into, the tubular lumen.The importance of the renal tubular reabsorption of organic substances is immediately apparent when one considers that most of the nutrients and vitamins in solution in extracellular fluid gain access to the glomerular filtrate.
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Recent post: | 1. - Death usually follows a period Post Date: Sat, 18 Oct 2008 17:21:59 +0000
may become scant, and the urine may be bloody and contain albumin and droplets of free fat. Cardio-vascular collapse results from both the metabolic derangements and a direct influence of phosphorus on the myocardium and blood vessels. Death usually follows a period of delirium and coma (Arena, 1973).
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| 2. - Treatment Post Date: Sat, 18 Oct 2008 17:10:29 +0000
Protracted exposure to lesser quantities of phos-phorus may produce chronic poisoning characterized by necrosis of bone, usually in the lower and upper jaw and the neighboring facial bones. In addition, there may be hepatic cirrhosis and chronic renal damage.Treatment.
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| 3. - The remaining therapy is addressed Post Date: Sat, 18 Oct 2008 16:55:57 +0000
If the patient has ingested phosphorus within 5 hours prior to being seen by the physician, it is desirable to employ gastric lavage. This is best accomplished by a solution of 0,1% copper sulfate in water, which tends to form an insoluble coating of copper phosphide. The remaining therapy is addressed primarily to combating the peripheral vascular collapse and the dehydration and acidosis.
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| 4. - Preparations Post Date: Sat, 18 Oct 2008 16:43:53 +0000
The mortality rate in acute poisoning cases is close to 50%.Phosphorus burns should be thoroughly washed with a 1% solution of copper sulfate and then treated like other burns.Preparations.
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| 5. - The phosphates are of limited Post Date: Sat, 18 Oct 2008 16:24:48 +0000
Only certain of the preparations of inorganic phosphates are mentioned here; calcium phosphates are described elsewhere, as are organic compounds that contain phosphorus.Therapeutic Uses. The phosphates are of limited therapeutic usefulness.
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| 6. - Phosphate salts are also effective Post Date: Sat, 18 Oct 2008 16:10:15 +0000
Sodium phosphate has been employed to diminish hypercalcemia (see page 787). The phosphates have a role in the management of the phosphate-depletion syndrome. Phosphate salts are also effective saline cathartics (see Chapter 49).
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| 7. - (See Bartter, 1964; see also Post Date: Sat, 18 Oct 2008 15:59:11 +0000
Pathological Conditions Associated with a Dis-turbance in Phosphate Metabolism. A defect in phosphate metabolism occurs in a variety of diseases, as briefly mentioned below. (See Bartter, 1964; see also Index.
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| 8. - There is no primary defect Post Date: Sat, 18 Oct 2008 15:45:14 +0000
)Osteoporosis. This condition is considered to be a primary disorder in the formation of bone matrix. There is no primary defect in phosphate metabolism, and plasma concentrations of phosphorus are within usual limits.
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| 9. - This tends to stimulate Post Date: Sat, 18 Oct 2008 15:25:15 +0000
Rickets. If the primary defect is a result of in-adequate quantities of vitamin D, the consequence is initially a failure adequately to absorb calcium and phosphate from the bowel. This tends to stimulate the secretion of parathyroid hormone, which, in turn, tends to raise the calcium concentration in theplasma toward normal but promotes increased ex-cretion of phosphate.
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| 10. - Other forms of rickets Post Date: Sat, 18 Oct 2008 15:13:09 +0000
With decreased absorption and increased excretion of phosphate, there is a fall in the plasma concentration. Familial hypophospha-temia is due to defective absorption and/or excretion of inorganic phosphate and has been mentioned above. Other forms of rickets are described in Chap-ter 76.
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