Although the acid-base equilibrium is first maintained by the buffers of the blood and other body fluids, the final removal of acid from the body is effected by the lungs, skin and kidneys. The expired air and the sweat are of peculiar significance as pathways for loss of metabolic acid, as all of the expired carbon dioxide and about half of the lactic acid of the sweat are removed without accompanying loss of base. In the kidney likewise there is a highly important mechanism for the excretion of acid without concomitant loss of fixed base; here it is the formation of ammonia from urea. The formation of this endogenous base in response to the administration of mineral acids was first noted by Walter in 1877. Magnus-Levy, in his classic monograph on diabetic acidosis, called attention to the augmented excretion of ammonia in the urine of such patients and suggested that
SIGNIFICANCE OF URINARY AMMONIA. JAMA. 1939;112(9):845–846. doi:10.1001/jama.1939.02800090055015
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