Concentrations of potassium in the serum of selected patients with hay fever
Derow, Matthew Arnold
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Studies in experimental animals and in human beings indicate a marked derangement ot the potassium balance during shock. The plasmapotassium content is found to increase when shock is produced by whatever means such as trauma, hemorrhage, visceral manipulation, drugs, or anaphylactic reactions. This increase in extracellular potassium has its origin in the diffusion of potassium ions from the cells. Moreover, excessive concentrations of potassium ions are injurious to cells and will thereby cause a further depletion of cellular potassium. The roles of potassium in metabolism seem to be: 1/ The chief intracellular base, playing the part within the cell that sodium does in the extracellular fluids; 2/ The maintenance of muscular tone by its balance against the effects of sodium and calcium ions; 3/ Antagonist to insulin and cholinesterase, and as an epinephrinc-like substance. The depletion of intracellular potassium following injury or excessive stimulation of cells makes further stimulation ineffective. However, if the medium surrounding the depleted cell contains available potassium ions, diffusion of this potassium back into the cell results in a recovery of the cell's ability to respond normally to new stimuli. On the basis of the relation of potassium to epinephrine and histamine reactions Rusk and Kenamore suggested the use of potassium salts in the treatment of urticaria. Their '"New Approach" consisted in the use of a high protein, low sodium, acid-ash diet, with the addition of potassium chloride. In 1938 Bloom reported successful palliative treatment of hay fever sufferers by the application of this "New Approach" of Rusk and Kenamore. Various other workers followed this original report with both corroborations and refutations of Bloom's claims. In no case had any of the investigators studied the variations if any, of the serum-potassium content of hay fever patients with reference to incidence of symptoms or type of treatment employed. Because of this dearth of data in regard to patients with hay fever it was deemed advisable to study a series of such people from the point of view of possible variations of the potassium level. The subjects in this series are for the great majority patients at the Allergy Clinic of the Massachusetts Memorial Hospitals. To have comparable conditions, as far as possible, in the individual cases of the series, the study was limited to uncomplicated cases of ragweed hay fever. In this way one could time fairly definitely the onset of exposure to the allergic excitant by checking with the advent of the ragweed pollinating season. The analytical procedure employed is the chloroplatinate micro-method of Consolazio and Talbott. This method was chosen because of its combination of a high degree of precision with a minimal amount of intricate manipulative detail. All analyses were performed in duplicate and occasionally in triplicate or quadruplicate. The median level of potassium for the entire series of forty-one patients is 5.23 milliequivalents per liter (20.42 milligrams per 100 milliliters) of serum. Although this represents only a slight increase over the median for a group of normal controls, statistical analysis of the data shows a definite divergence from normal in the distribution of individual values through the series. Thus the allergic individuals show a greater dispersion of the values of serum-potassium content than that of the normal series, as shown by the greater extent of the Q1 — Q3 interval and by the higher value of the coefficient of dispersion. This tendency toward individual fluctuations is more marked during the ragweed-pollinating season than before the onset of pollination. It is suggested that this fluctuation may represent a relative instability of the mechanism of regulation of potassium balance in the allergic individual as compared to that of the normal. It may also be a manifestation of a subclinical reaction to contact with the atopic excitant.
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