Immediate postoperative disturbances of water and electrolyte balance usually are corrected promptly by the adequate administration of isotonic solution of sodium chloride. Some instances of postoperative hypochloremia, however, are refractory to that procedure. This was noted first by Maddock as particularly common among patients with cancer of the gastrointestinal tract. He1 observed, furthermore, that when patients with this disorder began to eat an adequate diet the hypochloremia abated, but no explanation for this response was advanced. The existence of this type of hypochloremia now has been observed also in this hospital and appears to mark the postoperative course especially of patients with gastrointestinal disease.
Attention first is directed to these patients usually because of their lethargy, anorexia, nausea and increasing abdominal distention. Blood studies reveal hypochloremia, alkalosis and hypoproteinemia. The intestine gradually becomes inactive. Flat roentgenograms of the abdomen are consistent with the picture of intestinal obstruction, and at
ARIEL I, ABELS JC, PACK GT, RHOADS CP. METABOLIC STUDIES OF PATIENTS WITH CANCER OF THE GASTRO-INTESTINAL TRACT: XVI. THE TREATMENT OF HYPOCHLOREMIA REFRACTORY TO THE ADMINISTRATION OF SODIUM CHLORIDE, ESPECIALLY IN PATIENTS WITH GASTROINTESTINAL CANCER. JAMA. 1943;123(1):28–30. doi:10.1001/jama.1943.02840360030007
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