Changes in renal haemodynamics and electrolyte excretion during acute hyperkalemia in conscious adrenalectomized...

The p-aminohippurate (PAH) clearance, inulin clearance and the excretion of electrolytes by 10 adrenalectomized sheep were measured before, during and after the infusion of 0-43 M-KCl at 2 ml./min for 2 hr. The PAH clearance increased as the plasma potassium concentration increased up to approximately 6-0 m-mole/l. Further increases in plasma potassium were associated with a progressive return of the PAH clearance to or below the pre-infusion levels. At its maximum the PAH clearance was 1-228 +/- 0-032 (S.E. of mean) times the pre-infusion levels. The inulin clearance increased to reach a mazimum coincident with or subsequent to the maximum PAH clearance. The maximum level of inulin clearance during the hyperkalaemia was 1-158 +/- 0-020 times the pre-infusion clearance. The increments in the clearance of potassium and of bicarbonate rose rapidly to exceed the increment in inulin clearance during the hyperkalaemia in all experiments. The increments in the clearance of sodium and of chloride exceeded the increment in inulin clearance in more than half the experiments. It was concluded that although hyperkalaemia was associated with increased glomerular filtration much of the increased excretion of sodium, chloride and bicarbonate was derived from depressed tubular reabsorption of the ions. When the infusion experiments were repeated on the same animals the sheep demonstrated an improved ability to control the rise in plasma potassium concentration which was similar to potassium adaptation described in other species. There were no apparent differences between sheep maintained on 1-5 mg and 5 mg deoxycorticosterone acetate daily in their adaptation to potassium loading and the effect was tentatively attributed to the level of steroid maintenance being chronically high. The toxicity of hyperkalaemia was not lessened by this adaptation to potassium loading.