Moffitt, Emerson A.

Abstract A chromatographic system for organic acids has been developed, with improved stability, resolution, and sensitivity for measuring organic anions in biological samples. A calibration mixture containing 100 nEq each of 18 organic anions was clearly resolved, with a signal-to-noise ratio greater than 100:1. The baseline was essentially flat throughout the chromatogram. With scale expansion, the sensitivity limit was about 0.2 nEq per constituent. The width of each peak at half its height was 1 to 2% of its retention time. The system could thus resolve 50 or more constituents. In chromatograms of whole blood and urine more than 40 compounds are resolved. The system is basically a liquid-liquid partition between an acidified aqueous phase on silicic acid and a gradient of nonpolar and polar solvents. Eluted organic acids are detected photometrically by mixing the column effluent with a miscible solvent containing a suitable indicator. Samples require about 6 h for complete chromatography at present.

Cellular energy substrates and metabolites, electrolytes, oxygenation, and acid-base balance, in arterial and coronary sinus blood of seven adult patients who died after valvular replacements, were studied and compared with these measurements from five patients having aortic replacement who survived. Six of the patients were in New York Heart Association class IV. All but one died within 24 hr of acute circulatory failure, with excessive bleeding being a contributing factor. Plasma potassium and osmolality remained higher in the first postoperative hours in nonsurvivors. Ketone bodies, growth hormone, and lactate levels rose precipitously as shock became severe. Increased arterial blood osmolality and potassium, plus a still-rising lactate concentration, were evident 2 hr after operation in patients who died in the next 24 hr. Low cardiac output, hyperosmolality, and the degree of lactic acidosis were the only early changes predicting the fatal outcome.

Closed-chest massage and defibrillation were used successfully in the management of six acute cardiac emergencies occurring in a cardiac catheterization laboratory. A modification of the Kouwenhoven method of closed-chest massage was used in infants and small children. It is concluded that open-chest resuscitation is usually unnecessary during cardiac catheterization.