• No results found

EFFECT OF AGE, SEX, AND CYSTIC FIBROSIS ON THE SODIUM AND POTASSIUM CONTENT OF HUMAN SWEAT

N/A
N/A
Protected

Academic year: 2020

Share "EFFECT OF AGE, SEX, AND CYSTIC FIBROSIS ON THE SODIUM AND POTASSIUM CONTENT OF HUMAN SWEAT"

Copied!
10
0
0

Loading.... (view fulltext now)

Full text

(1)

EFFECT

OF

AGE,

SEX, AND

CYSTIC

FIBROSIS

ON

THE

SODIUM

AND

POTASSIUM

CONTENT

OF

HUMAN

SWEAT

Charles C. Lobeck, M.D., and Dorothy Huebner, B.S.

Department of Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin

Supported by grant A-2815 from the National Institute of Arthritis and Metabolic l)isease and by

gifts from the Wisconsin Chapter, National Cystic Fibrosis Research Foundation. ADDRESS: (CCL.) 1300 University Avenue, Madison 6, Wisconsin.

P1r.I3IAUUC5, August 1962

ARTICLES

172

T

HE OBSERVATION

by

Darling et ai.1 that

the eccrine sweat of children with

cystic fibrosis of the pancreas has greater

concentrations of sodium, potassium, and

chloride than those found in healthy

sub-jects has given new impetus to studies of

the physiology of sweating. These high

concentrations, which are found in almost

every clinical case of the disease, are not

only of unquestioned diagnostic value but

also may be of importance in considerations

of etiology.

The study of sweating in cystic fibrosis

requires an awareness of the sources of

variability in the composition of the sweat

of healthy, active individuals. The most

im-portant of these sources, which have been

previously described, are the increase in

sweat sodium and chloride concentrations

with increased rates of sweating,2’3 the

ef-fect of adrenal activity, exemplified by the

high sweat sodium and chloride

concentra-tions found in Addison’s disease,4 and the

recently described increase in sweat sodium

content with aging.5 Other factors, such as

increase in deep skin temperature,6

inter-mittent occlusion of blood supply, and

re-peated stimulation of secretion8 can cause

increases in sweat sodium and chloride

con-centrations. These are more easily

con-trolled in experimental situations.

The search for incomplete expressions of

the sweat abnormality of cystic fibrosis in

parents and siblings of children with this

disease, or in patients with similar

syn-dromes, gives further impetus to the study

of variations in the electrolyte content of

sweat from healthy, unrelated subjects. For

instance, several observers9’ have reported abnormally high sodium and chloride con-centrations in some of these parents and siblings. Other observations have revealed that some patients with bronchiectasis,2

pulmonary emphysema,1:: asthma,hi and

peptic ulcers’ have elevated sweat sodium

and chloride concentrations. The

interpre-tation of these findings depends upon the

range of variation that can be observed in

control subjects.

This paper describes the variability in

sweat sodium and potassium concentra-tions, with measurements of tile rates of

sweating, following a standard pilocarpine

iontophoresis procedure in children with

cystic fibrosis, their siblings and parents, as

compared to control children and adults of

both sexes and varying ages.

METHODS

The control subjects consisted of 197

children and adults varying from 1 month through 60 years of age. Some of tile

cliii-dren under 11 years of age were

hospital-ized for diseases not clinically related to

cystic fibrosis. Results obtained from these

children did not differ from those of

healthy children of the same age. All of

the adolescents and adults were healthy

and active without pulmonary disease or clinical evidence of ulcers. Controls were compared to 34 patients with cystic fibrosis

who had abnormally high electrolyte

con-centrations in sweat with evidence of either

(2)

or foul 1)tllky stools and a slow rate of

growth and osseous maturation. These

pa-tients were seen and studied by one of the

authors (C.L.). Fifty-three parents and 18

siblings of these patients, all healthy and

active, were also studied.

Each of the subjects was a resident of

either Wisconsin or Northern Illinois. All

sweat collections except those of the

cliii-dren with cystic fibrosis were made

he-tween the dates of September 12 and June

5. The average monthly environmental

temperature for Madison varied between

17#{176}Fand 64#{176}Fduring this period.

Sweat was collected following

pilocar-pine iontophoresis from the flexor aspects

of either forearm in an air conditioned

room with a temperature of approximately

72#{176}Fand relative humidity of 60 to 70%.

The direct current source for pilocarpine

iontophoresis was constructed similarly to

that of Gibson and Cooke.3 The electrodes

employed were circular with a porous metal

base topped by a reservoir. Their diameter

was 3.1 cm and their surface area 7.54 X

10 square meters. The positive electrode

was filled with an aqueous 0.5% pilocarpine

nitrate solution and the negative with an

aqueous 1.0% NaNO:: solution. To prevent

burns and the stinging sensation that

occa-sionally occurs during iontophoresis, the

surface of the positive electrode was

cov-ered with a circle of ashless filter paper

saturated with pilocarpine nitrate and the

negative electrode wrapped with a gauze

saturated with NaNO:s solution. The

posi-tive electrode was held firmly in place at

about the midpoint of the flexor surface of

the forearm and the negative electrode

op-posite it on the extensor surface with a

rubber strap.

A current of 1.5 ma was passed through

the arm for 5 minutes. The electrodes were

then removed and another 5 minutes

al-lowed to elapse before tile area previously

occupied by tile positive electrode was

carefully washed with distilled water and

covered with a circle of tared no. 42

What-mann ashless filter paper of tile same

sur-face area as the electrode. A vapor barrier

of parafilm was taped over the filter pa-per, and sweat was collected for 25 to 35

minutes. The collection period was

care-fully timed to determine its exact length

within these iimits, for determination of the

rate of sweating. For purposes of

compari-son, the use of collection periods of

ap-proximately equal length was necessary,

since in preliminary experiments on adults

the rate of sweating and sodium

concentra-tion of the sweat decreased continuously

during the 30-minute period. Thus, varying

the length of the collection period between

subjects could be a source of variation in

observed electrolyte concentrations and

rates of sweating.

The weight of sweat collected was

de-termined by weighing the filter paper on

an analytical balance immediately after

col-lection. Since the area from which the

col-lection was obtained and the exact time the

paper was in contact with the skin were

known, the grams of sweat secreted per

square meter of skin per minute (gm/m2/

mm) was calculated to express the rate of

sweat secretion during the 30-minute period.

Electrolytes were eluted from the paper

by washing twice with 10 ml of distilled

water. The eluate was centrifuged and

ali-quots of the supernate were used for the

analysis of sodium and potassium in a

Baird Associates flame photometer with

lithium as an internal standard. In recovery

experiments, with the same technique and

aliquots of the same volume as in the

un-known sweat samples, it was found that

the maximum experimental error was

ap-proximately 10% if more than 0.001 meq of

sodium was present in the original sample

while less than this amount gave a

maxi-mum error of 25%. In the case of potassium,

a maximum error in the analysis of 6% was

obtained, but it was found that the elution

procedure increased this to 20% at all levels

of potassium concentration observed in the

sweat samples.

RESULTS

(3)

Sweat Rate Sweat Na Sweat K

Subj eel.Number (giu/in2/min)

Arerage ± SD#{176} Range

(iiieq/l) (meq/l)

.4rerage ± Sl)*

Average ± SD* Range

7.8±4.5 1.7-19.7 10.7±3.6 3.8-’20.1

8 6.1±’2.0 3.’2-9.1 11.4±3.6 5.4-16.’2

‘25 6.1±3.0 ‘2.5-14.1 17.9±8.7 7.1-38.0

17 5.6±’2.8 ‘2.l-1’2.4 16.7±8.7 6.1-37.9

6-10 yr

9.9±3.’2 (14)

11.3±3.4 (16)

7.5±1.6 (14) 10.0±2.1 (6)

11-19 yr

Male

Felnale

‘20-6(1 yr

Male

Female

Patients with cystic fibrosis

3 mo-17 yr

Male

Felnale

Parents

‘26-5’2 yr

Male

Female

Siblings

3-15 yr

MIlk

F’elnak-* Standard deviation.

7.1±0.9(11) 10.0±’2.5 (15)

10.1±1.6 (4)

9.9±3.’2 (8)

t Numbers in parentheses refer to number of subjects with potassium analyses.

period after pilocarpine iontophoresis are

shown in Table I. Adult males in both the

group of control subjects and parents of

children with cystic fibrosis had

signifi-cantly higher rates of sweating than

fe-males (p <0.001). This sex difference was

not found during childhood.

Greater variability in observed rates of

sweating was noted in infants under 1 year

of age than in older children. In the former

group, 8 subjects, or 27%, had sweat rates

above 10 gm/m2/minute; only 6% of the

108 remaining control subjects under 20

years of age had rates above this figure. Of

these 15 children in both groups with high

rates of sweating, 13 were male. The same

increased variability in sweat rates was

ob-served in infants with cystic fibrosis. Three

of 7 under 2 years of age as compared to 2

of 27 older children had rates higher than

TABLE I

AGE AND SEX VARIATION IN TIlE RATE OF SWEATING, SWEAT SoDIUM, AND POTASSIUM (0NCENrIIATION

Controls

1-PI 1110 Male

Feinalt-1-5 yr Male

Felnale

Male

Female

15 3.7±1.6 .1-7.7

13 3.9±.l I.-9.()

16.5±5.8 7.1-i8.3

20.6±9.7 1’4.0-46.5

10.7±1.9 (9)t

loi.8±1.6 (‘2)

10.’2±3.1 (10)

11.’2±_.’2 (9)

11.1 ±1.9 (l’2) 9.8±1.5 (8)

‘20 5.7±3.3 0.9-15.9 6.9±13.3 5.3-5’2.’2

18 4.3±3.4 0.9-17.’2 ‘26.3±13.1 7.4-61.3

33 7.±1.8 3.5-11.9 51.9±’21.1 9.9-96.4

‘26 4.6±1.6 ‘2.1-8.8 36.5±18.7 9.5-80.1

16 7.0±.9 ‘2.-14.8 111.6±16.’2 87.6-141.’2 16.1±5.1(5) 18 5.8±.7 1.0-10.9 106.3±’24.8 54.9-158.’2 14.0±’2.3(6)

‘2’2 6.’2±.5 ‘2.3-11.3 45.1±17.7 ‘2.4-84.8

31 4.0±’2.() 1.3-9.1 39.’2±’20.6 5.9-86.3

8 4.6±3.3 oL4-1’2.4 ‘21.7±10.5 7.7-39.1

(4)

0 #{149}

oFEP ALE

#{149}MA E

a. V E

<50 z

I-w

I/)

00

#{149} #{149} 0

#{149}#{149} 9o

0 #{149} #{149}

.0

S

cP

0

S

0

S

OS

.#{149}

S

S #{149}

#{149}S

0

0 5

#{149}#{149}#{149} 8..

#{149}

0 0#{149}

#{149}

S #{149}#{149}#{149}#{149}

0 00

Oo

0 #{149}

0 0

0 #{149}

0 0

0 #{149}

0 00 #{149}

5 I0

ARTICLES 175

PARENTS CONTROLS

10 0

RATE OF SWEATING (gm/m’/minute)

FIG. 1. Relationship of sweat sodium concentrations to rates of sweating in adults, in (left) 22 fathers and 31 mothers of children with cystic fibrosis, varying from 26 to 5:3 years of age, and (right) 33 male and 26 female control adults varying from 20 to 61 years of age. (Coefficients of correlation: parents,

R = 0.34, p < th05; controls, R = 0.42, p < 0.01.)

10 gm/m2/minute. Only two of the five

children with high rates were males. There

were fl() differences observed in rates of

sweating between siblings of children with

cystic fibrosis and control children of the

same age. In other words, sex differences in

tile rate of sweating were not marked until

adulthood, but there was much more

vari-ability in the rates of sweating induced in

infants with or without cystic fibrosis. A

preponderance of the children with high

rates were males.

Sweat sodium concentration increased

with age. As shown in Table I, under the

age of 1 year there was a very low average

sodium concentration, which increased

slowly during the ensuing years until the

adult value was reached after the age of

20. In adults the variability of these

concen-trations was much greater than in children.

No differences in the sodium

concentra-tions were observed between parents and

control adults or between siblings and

con-trol children. Tile variability of these

con-centrations also did not differ between

these groups. As with the rates of

sweat-ing there were no sex differences in sodium

concentration under tile age of 20 years; in

adulthood, however, males in the control

group had higher sodium concentrations

than females (p < 0.01). Concentrations in

control children and siblings did not over-lap the distinctly higher concentrations in children with cystic fibrosis. This indicates

the value of this determination for

diag-nosis during childhood. Values in adults,

however, did overlap considerably those in

children with cystic fibrosis; 29% of tile

values in control adults and parents of the

patients with cystic fibrosis were over 55

meq/l, the lowest concentration for a child

with the disease.

The relationship of sweat sodium concen-tration to rate of sweating is shown in Figures 1, 2, and 3. In control adults, chil-dren with cystic fibrosis, and their parents

(Figs. 1 & 2), though great variability

between subjects was observed, the

high-est sodium concentrations were found at

tile highest rates of sweating. This was not

true in control children from 1 month to 11

years of age where the highest sodium

con-centrations were found at the lowest rates

of sweating (Fig. 3). Comparison of the

parents of the children with cystic fibrosis

and control adults (Fig. 1) revealed no

sig-nificant differences. In the parent group the

higher sodium concentrations at lower rates

of sweating and the absence of low sodium

(5)

I MONTH TO IIYEARS

oFEMALE

#{149}MALE

0 #{176}

#{149}.:#{149}s

00 #{149}

176 CYSTIC FIBROSIS

a. V E .<

z oc

I-LU

1-fl

I I I I I I I

50 CYSTIC FIBROSIS

#{149} S

0

#{149} 0#{149} I

0 .1 o5

So#{176}0 05

0

#{149} 0

0 #{149} 0 FEMALE

0 SMALE

50i#{176}i I I I I I I

0 0

RATE OF SWEATING (gm/m2/minute)

15

FIG. 2. Relationship of sweat sodium concentrations

to rates of sweating in children with cystic fibrosis.

The 34 subjects were between 3 months and 18

years of age. (R = 0.39, p = 0.05.)

was probably due to the fact that 58% of

this group was comprised of females, whereas only 44% of the control group were

females.

The sweat potassium concentrations are

shown in Table I. In childhood, the

aver-age sweat potassiums showed no sex

differ-ences and remained remarkably constant.

In adulthood, males had significantly lower

values than females, who remained at the

childhood level. Again parents and siblings

of children with cystic fibrosis did not

dif-fer from control subjects of the same age

and sex. However, children with cystic

fi-brosis had significantly higher potassium

concentrations than other children.

In the case of potassium, there also was a

relationship of concentration to rate of

sweating, but the highest potassium

con-centrations were found at the lowest rates

of sweating in all age groups. These

rela-tionships are shown in Figure 4; in control

adults and parents of children with cystic

fibrosis, the females with the lower rates of

sweating had higher potassium

concentra-tions while the males had low

concentra-tions at all sweat rates. As stated

previ-ously, it will be noted in Figure 4 that only

3 male control children had potassium

con-centrations below 8 meq/l at any rate of

sweating, while 20 control males had

con-centrations below this figure, but none

lower than 5.5 meq/l. Children from 11

through 19 years of age were intermediate

between these two age groups. The 11

children with cystic fibrosis whose sweat

was analyzed for potassium showed no

dis-tinct relationship of potassium

concentra-tions to rates of sweating. It was noted,

however, in this small group, that there

was a tendency to higher potassium

con-centrations at high rates of sweating rather

than at low rates; the four highest

potas-sium concentrations were at rates of

sweat-ing above 7 gm/m2/minute, and five of the

lower values were at lower rates.

COMMENT

Our results confirm the observation by

Anderson and Freeman5 that the sodium

concentration of tile sweat is lower and less

variable in prepubertal children than in

adults. These investigators using the

intra-dermal injection of methacholine chloride

and collecting sweat for 1 hour obtained

results essentially identical to ours despite

the differences in technique. Data are not

available for comparing our results with

those from sweat obtained after thermal

stimulation. Gr#{216}nbaek,17 however, observed

marked increase in tile average Na/K ratio

of the sweat with aging in collections from

the hand following thermal stimulation.

The magnitude of the change he observed,

from 1.24 in children under 9 years to 3.25

40

a.

30

z

I.-20

U.,

0

A

CONTROLS

0 5 0 5

RATE OF SWEATING (gm/m2/minute)

FIG. 3. Relationship of sweat sodium concentrations

to rates of sweating in 100 control children-38

(6)

II.

a. U, E

I-io

5

0 II

S #{176}

S #{149}

S

Oo#{149}

S

IllIllil III [I 11111111111

o CONTROL FEMALE A

-#{149}CONTROL MALE

I

23 TO 53 YEARS

-a FEMALE PARENT I

-I

5 a MALE PARENT

J

-A

5 0

S #{149} A 0

S

A

#{149}#{149} A

0 #{149} 0A3o

AS

---

S a A -#{149}

S a #{149}6 a 5

MONTH TOIIYEARS

II I 1 1111 11__J.___i1 I I I I I I I 1 I I

5 10 0, 5 0

RATE OF SWEATING (gm/m’/minute)

FIG. 4. Relationship of sweat potassium concentrations to rates of sweating. On

the left are shown data from 50 control children; on tile right, from 20 control

adults and 26 parents of children with cystic fibrosis. (Dashed line is at 8 meq/l.)

CONTROLS

< 5 gm/m2/min.

50

--->7

gm/m2/min.

gm/m2/min.

a-E

z

I-1<

w

1’

10

I I

I MO-5

6-10

11-19

20-61

AGE (YEARS)

FIG. 5. Increase in sweat sodium concentration

with increasing age. Independence of age

varia-tion from rate of sweating demonstrated by lines

drawn through average sweat sodium

concentra-tions of subjects grouped as to rates of sweating. in adults over 30 years, indicates that it

must have been due largely to increase in

sweat sodium concentration. From our data

it is clear that the increase in sodium

con-centration with aging is independent of

variations in the rate of sweating (Fig. 5).

Increase in sodium or chloride

concentra-tion with increasing rates of sweating has

been previously described by several

in-vestigators.2- Our data suggest that this

relationship holds true only in adults and

in one group of children, those with cystic

fibrosis. Its presence in the latter group

in-dicates that this relationship of sodium

con-centration to rate of sweating depends

upon tile presence of high concentrations of

sodium in the secreted sweat and not on

age alone.

In control children, the relationship of

sodium and potassium concentrations to the

rate of sweating were similar, i.e., the

high-est concentrations of both cations were

found at the lower rates of sweating.

How-ever, no correlation between sodium and

potassium concentrations were observed

(R = 0.10), indicating that the higher

so-dium and potassium concentrations in this

group were not simply the effect of water

reabsorption in the gland.

It has been postulated by Schwartz and

Thaysen2 that the reason for the depend-ency of sodium concentration on the rate

of sweating in adults is the ability of tile

tubule of the gland to reabsorb a relatively

fixed quantity of sodium from the initial

secretion. In the light of this hypothesis,

our data suggest that children with cystic

fibrosis, their parents, and healthy adults

(7)

178 CYSTIC FIBROSIS

This would indicate that, in cystic fibrosis,

the primary secretion has an abnormal

com-position and that the defect is not simply

one of failure of reabsorption.

Marked sex differences were noted in

adults whether or not they were parents

of children \Vitil cystic fibrosis. The

obser-vation that women had lower sweat rates

than men confirms the findings of several

Otiler investigators18 19 that women sweat

less than men in response to a standard

stimulus. Tile lower sodium concentrations

observed in women are probably due to the

low rates of sweating produced. However,

in women, potassium concentrations were

variable and tended to be at the same level

found in children, while men had lower

potassium concentrations than children at

all rates of sweating. Thus, we have

ob-served two attributes of the adult male:

(

1) increase in tile responsiveness of the

sweat gland to stimulation and (2) secretion

of a sweat potassium concentration

ap-proaching tllat of extracellular fluid.

If the widely ileld contention that cystic

fibrosis is transmitted as an autosomal

re-cessive characteristic is correct,2#{176} then each

one of the parents silould carry tile trait.

From our data it is obvious that a partial

expression of the sweat abnormality

can-not be detected on the basis of a single

sweat electrolyte determination after

pilo-carpine iontophoresis. Since survival of

chil-dren with the disease to adulthood is a

rarity, the many differences described

above between children and adults make

it important to compare children with

cys-tic fibrosis only witil other cilildren of tile

same age. Assuming the autosomal

reces-sive inheritance, 66% of tile healthy children

born to families having a child with cystic

fibrosis should also be heterozygous. Tile

small number of siblings of children with

cystic fibrosis in tilis study reveal no

dif-ferences from unrelated children. Age

dif-ferences must also be kept in mind when study is made of patients with related

ill-nesses. The values reported as indicating

excessive sweat salinity in asthma,”

bron-clliectasis,12 peptic ulcer,” and pulmonary

emphysemaH are all within tile range we

have observed for adults without these

conditions.

Tile data reported in this paper also

demonstrate tile wide variability in tile response to a standard stimulus between

healtily people of tile same age. It is

pos-sible that much of this variation is due to

slight differences in the number of sweat

glands present in the area subjected to iontophoresis. Kuno2’ has reported

obser-vations by Kawahata that though tile total

number of sweat glands in various areas of

the skin remains constant after 2 years of

age, before that time tile glands, though

fewer in total number, may be more

con-centrated per unit surface area. This could

explain the greater sweat rates obtained in

some cilildren under 1 year of age but

would not explain the sex differences in tile

rates of sweating observed in adults.

SUMMARY

The following observations were made

on collections of sweat from 197 subjects

witilout evidence of disease related to

cys-tic fibrosis of the Paicreas after production

of localized sweating on the forearm by a

standard pilocarpine iontophoresis

proce-dure : 1. Sodium concentrations averaged

less than 20 meq/l in children under 11

years of age, while in adults the average

concentration rose to 45 meq/l. Sodium

concentrations were less variable in

chil-dren than in adults. Age variation in

so-dium concentration did not depend upon

variation in tile rate of sweating. 2. Tile

average potassium concentration in all

children and adult females was 11 meq/l.

It was lower, 7 meq/l, in adult males. 3.

Other sex differences, observed only in

adults, were tile higiler rates of sweating

and sligiltly iligher sodium concentrations

found in males. 4. Rates of sweating

meas-ured in children under 1 year of age were

considerably more variable than tilose

in-duced in older children or adults.

Comparison of tilese data with

observa-tions from 34 children with cystic fibrosis

(8)

ARTiCLES 179

with this disease always had higher sodium

concentrations than pre-pubertal control

subjects. Twenty-nine per cent of adult

control subjects had concentrations within

tile cystic fibrosis range. 2. Children with

cystic fibrosis had a higher average

potas-sium concentration, 15.0 meq/l, than

con-trol children. 3. No sex differences were

oh-served within this group, and tile same

in-creased variability in rates of sweating

in-duced in control infants was noted in

in-fants with the disease.

Observations on 53 parents and 18

sib-lings of the children with cystic fibrosis did

not reveal any differences from control

sub-jects of the same age. It was concluded that

age, sex, and the presence of cystic fibrosis

have a profound effect on the composition

of sweat obtained after pilocarpine

ionto-phoresis.

REFERENCES

1. Darling, R. C., et a!.: Electrolyte

abnormali-ties of the sweat in fibrocystic disease of the

pancreas. Amer.

J.Med.

Sci., 225:67, 1953. 2. Schwartz, I. L., and Thaysen, J. H.:

Excre-tion of sodium and potassium in human sweat. J. Clin. Invest., 35:114, 1956.

3. Locke, W., et a!.: Studies on combined use

of measurements of sweat electrolyte

com-position and rate of sweating as an index

of adrenal cortical activity.J. Clin. Invest.,

30:325, 1951.

4. Conn, J. W.: Electrolyte composition of sweat.

Arch. Intern. Med. 83:416, 1949.

5. Anderson, C. M., and Freeman, M.: “Sweat test” results in normal persons of different ages compared with families with fibrocystic disease of tile pancreas. Arch. Dis. Child.,

35:581, 1960.

6. Robinson, S., et a!.: Effect of skin

tempera-ture on salt concentration of sweat.

J.

Appl.

Phvsiol., 2:654, 1950.

7. van Heyningen, R., and Weiner,

J.

S.: Tile

effect of arterial occlusion on sweat compo-sition.

J.

Physiol. (Lond.), 116:404, 1952.

8. Sibinga, M. S., and Barbero, C. J.: Studies in

the physiology of sweating in cystic fibrosis.

PEDIATRICS, 27:912, 1961.

9. di Sant’Agnese, P. A., et a!.: Sweat electrolyte disturbances associated with childhood pan-creatic disease. Amer. J. Med., 15:777,

1953.

10. Shwachman, H., and Leubner, H. :

Muco-viscidosis. Advance. Pediat., 7:249, 1955.

11. Smoller, M., and Hsia, D. Y. Y.: Studies on

the genetic mechanism of cystic fibrosis of

the pancreas. J. Dis. Child., 98:277, 1959.

12. Peterson, E. M. : Consideration of cystic fibro-sis in adults with a study of sweat electro-lyte values. J.A.M.A., 171:1, 1959.

13. Wood, J. A., et al.: A comparison of sweat

chlorides and intestinal fat absorption in

chronic obstructive pulmonary emphysema

and fibrocystic disease of the pancreas. New Engl. J. Med., 260:951, 1959.

14. Hsia, D. Y. Y., et a!.: Abnormal sweat

electro-lytes in patients with allergies. J. Dis. Child., 96:685, 1958.

15. Koch, E. : Hereditary adult mucoviscidosis and

its relationship to peptic ulcer. Deutsch.

Med. \Vschr., 84: 1773, 1959.

16. Gibson, L. E., and Cooke, R. E. : Test for concentration of electrolytes in sweat in

cystic fibrosis of the pancreas utilizing pilo-carpine by iontophoresis. PEDIATRICS, 23:

545, 1959.

17. Cr#{216}nbaek, P. : Tile sodium/potassium ratio in

thermal sweat in patients with rheumatoid arthritis. Acta Rheum. Scand., 6:102, 1960.

18. Gibson, T. E., and Shelley, \V. B.: Sexual and

racial differences in tile response of sweat

glands to acetylcholine and pilocarpine. J.

Invest. Derm., 11:137, 1948.

19. Kahn, D., and Rothman, S.: Sweat response

to acetylchohne. J. Invest. Derm., 5:431,

1942.

20. Hsia, D. Y. Y.: Inborn Errors of Metabolism.

Chicago, Yr. Bk. Pub., 1939, p. 198. 21. Kuno, Y.: Human Perspiration. Springfield,

Thomas, 1956, p. 68.

Acknowledgment

We are particularly grateful for the enthusiastic

cooperation of the parents, patients, and control

subjects who participated in this study. We are also indebted to Dr. Gerald Kerrigan and the staff of the Milwaukee Children’s Hospital, to the staff

of the Wisconsin High School, and to Dr. Arthur

(9)

1962;30;172

Pediatrics

Charles C. Lobeck and Dorothy Huebner

POTASSIUM CONTENT OF HUMAN SWEAT

EFFECT OF AGE, SEX, AND CYSTIC FIBROSIS ON THE SODIUM AND

Services

Updated Information &

http://pediatrics.aappublications.org/content/30/2/172

including high resolution figures, can be found at:

Permissions & Licensing

http://www.aappublications.org/site/misc/Permissions.xhtml

entirety can be found online at:

Information about reproducing this article in parts (figures, tables) or in its

Reprints

http://www.aappublications.org/site/misc/reprints.xhtml

(10)

1962;30;172

Pediatrics

Charles C. Lobeck and Dorothy Huebner

POTASSIUM CONTENT OF HUMAN SWEAT

EFFECT OF AGE, SEX, AND CYSTIC FIBROSIS ON THE SODIUM AND

http://pediatrics.aappublications.org/content/30/2/172

the World Wide Web at:

The online version of this article, along with updated information and services, is located on

American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

References

Related documents

It was concluded that Primary Branches, Secondary Branches and Tertiary Branches have a downward trend in line with the storage times of scion of Carbohydrate

In the case of common source stage, the M9/M11 help introduce a gain peak which is higher than the one generated by the first noise cancelling stage and therefore, two gain

In order to evaluate whether our KIFE feature extraction method actually results in a new space that characterizes the difference between features better, we perform our

The extracts prepared from dry mat- ter of wormwood ( Artemisia absinthium L.) at 10% concentration, and from fresh matter with 30% concentration result in more than three-

Achievement of IL by students was assessed as higher amongst four-year institutions (58%) than among two-year institutions (49%). The fact that only half of two-year college

Although some at-risk groups are increasingly recognized as such, the risks faced by prisoners and detainees are often overlooked. The scope of violence against them is unknown

An ideal wiki article comprises following components: Title (e.g. The Australian financial crises); Relevant policy domain(s) (e.g. finance, economy); A brief

According to this law, whenever a current carrying conductor cuts the magnetic lines of force,an emf is induced in the conductor, the magnitude of eddy current is