58 Paul Fourman and Patricia M. Leeson 



RosENBAUM, J. D. (1957). In Essays in Metabolism, ed. Welt, L. G. 



Boston: Little, Brown, and Co. 

 SCHOEN, E. J. (1957). J. appl. Physiol, 10, 267. 

 Schwartz, W. B., Bennett, W., Curelop, S., and Bartter, F. C. 



(1957). Amer. J. Med., 23, 529. 

 Sims, E. A. H., Welt, L. G., Orloff, J., and Needham, J. W. (1950). 



J. din. Invest., 29, 1545. 

 Smith, H. W. (1957). Amer. J. Med., 23, 623. 

 Stevenson, J. A. F., Welt, L. G., and Orloff, J. (1950). Amer. J. 



Physiol, 161, 35. 

 Strauss, M. B. (1957). Body Water in Man. London: Churchill. 

 Talso, p. J., Spafford, N., and Blaw, W. (1953). J. Lab. din. Med., 



41, 281. 

 Verney, E. B. (1957). Lancet, 2, 1237, 1295. 

 Welt, L. G., Seldin, D. W., Nelson, W. P. Ill, German, W. J., and 



Peters, J. P. (1952). Arch, intern. Med., 90, 355. 

 Wesson, L. G., Anslow, W. P., Raisz, L. G., Bolomey, A. A., and 



Ladd, M. (1950). Amer. J. Physiol, 162, 677. 

 Weston, R. E., Hanenson, I. B., Grossman, J., Berdasco, G. A., and 



WoLFMAN, M. (1953). J. din. Invest., 32, 611. 

 Whedon, G. D., and Shorr, E. (1957). J. din. Invest., 36, 941. 

 Wilson, A. O. (1955). BriL J. Surg., 43, 71. 

 Wolf, A. V. (1950). Amer. J. Physiol, 161, 75. 

 Wrong, O. (1956). Clin. Sci., 15, 401. 

 Wynn, V. (1956). Metabolism, 5, 490. 

 ZiLVA, J. F., and Harris-Jones, J. N. (1957). J. din. Path., 10, 156. 



DISCUSSION 



Wallace : Hypernatraemia is seen very frequently in young infants with 

 dehydration secondary to diarrhoea. I think that there are two points 

 worth noting here. The first is that infants can lose large amounts of 

 water in their stools without losing physiologically equivalent amounts of 

 sodium. The sodium content of stool water can be very low. It is almost 

 as though the gut contents had been passed over an exchange resin. The 

 second item is that, in infants at least, the hypernatraemia is accom- 

 panied by an ever greater degree of hyperchloraemia. Since the flame 

 photometer came into the laboratory chloride has been a neglected ion. 

 We have wondered whether or not chloride might not be an ion with 

 much more autonomy than it is generally given credit for. In the child- 

 ren we have studied, gain of water and loss of chloride have been the 

 primary measurable events occurring during clinical recovery. 



Davson: Does the gut remove the sodium from the normal faeces? 



Wallace: In normal faeces there is very little sodium. 



Davson : It may be that the active accumulation mechanism is set to 

 take up any sodium that is in the gut. 



Wallace : A few stools from infants with the salt-losing type of adreno- 

 genital syndrome and with concurrent diarrhoea have been examined. 

 The sodium in stool water from these infants has been found to be much 



