266 D. A. K. Black 



The mean urinary pH in these two patients was 6 • 26 and 6 • 67, 

 no more acid than specimens from two 'controls' with mean 

 pH of 6-48 and 6*20. The mean excretions of bicarbonate 

 were 7-5 and 15-2 m-mole/day, compared with 10-1 and 

 4-8 m-mole/day in controls. Ammonium excretion was some- 

 what higher, and titratable acidity somewhat lower in the 

 patients with respiratory acidosis than in the controls, and it 

 has been reported that renal glutaminase is increased in 

 experimental respiratory acidosis. There were no striking 

 differences in 24-hour output of sodium, potassium, or 

 chloride. These findings are consistent with the view that 

 renal adaptation has included increased synthesis of ammonia, 

 allowing the excretion of hydrion at a higher urine pH than 

 in acute respiratory acidosis, without increase in urinary 

 buffer (the excretion of phosphate was lower than in the 

 controls). 



In preliminary observations on four patients with respira- 

 tory acidosis, my colleague Dr. J. Timoner has found a pH 

 range in urine of 5 • 1 to 6-7, with ammonium excretion up to 

 65 [jL-equiv./min. and titratable acidity up to 60 [ji-equiv./min. 

 After a standard load of ammonium chloride (0-1 g./kg. body 

 weight), two patients excreted 76-5 and 81-3 [ji-equiv. of 

 ammonia, and 26 • 3 and 46 • 2 [x-equiv. of titratable acid per 

 minute. The ammonium excretion is just above the normal 

 range found by Davies and Wrong (1957). These two patients 

 were aged 57 and 60, and seem to have retained the capacity 

 of the renal tubule cells to form ammonia in response to an 

 acid stimulus. 



Renal function in cor pulmonale. In the cardiac failure 

 associated with emphysema, the cardiac output is commonly 

 increased, and the patient has warm extremities. Terminally, 

 the limbs become cold, the blood pressure falls, and the 

 cardiac output at this stage is reduced. Davies and Kil- 

 patrick (1951) showed that even in the high-output phase of 

 cor pulmonale the circulation through the kidneys and the 

 glomerular filtration rate were substantially diminished. 

 These findings have been confirmed by Lewis and his co- 



