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On the living patients it is passible by placing them on the artificial kidney
and hy adjusting the fluid bath, which controls the dialysis, to differentially modify each
of these three components in individual cases and to determine its effect on comatose
states In patients.
It is also possible to checkthis with sginalfluid determinations.
In the experiments that have been setup on animals we have living for periods
of taro to four days uremic rats and. rabbits whose kidneys have been removed or whose
kidneys are non-excreting because of ligation of the ureters.
In the initial experiment
on these animal
-we have been interested in simple fluid redistribution, in the uremic
state.
It has been known for some time that patients dying of uremia may show increased
fluid accumulation in any or all of the serous cavities.
In other words, they show an
accumulated transudate in the peritoneal cavity, in the pericardial cavity, in the pleural
cavity or in the meningeal cavity of the subarachnoid space.
In the control animals and
in many patients, death from uremia occurs before this change in fluid distribution has
occurred.
In our experiments, by giving cortisone we can markedly increase the transu-
dating fluid in all of these cavities and therefore produce at will cerebral edema along
.
with increased fluid in the other serous cavities while the animal is still alive.
This
change in the distribution of fluid is important since in all the textbooks on uremia prior
to recent potassium studies^W the uremic state as exemplified by psychoses and coma,
was thought to be due to cerebral edema or simple wet brain.
One of the most striking
bits of ignorance that were confronted in these studies is the fact that although it has
been known for hundreds
of years that there is such redistribution of fluid in the serous
cavities, no one has ever raised the question whether it is due to increased rate of effusion
or delayed rate of absorption, or both.
It is becoming increasingly evident in the study of abnormal fluid distribution
in the body that there are two major controlling factors.
One of these is the chemical
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