Small-bowel ulceration induced by potassium chloride.

Stone Dissolution-Lotz and Bartter MMrFCLJOISE 1409 achieved simply by stopping therapy until symptoms subside-usually in four to five days-and then resuming therapy gradually with increasing doses over several weeks. We have used n-pen. successfully now in two patients with well-documented histories of penicillin allergy. Previously it was our belief that D-pen. would be effective only in preventing de novo stone formation or progression of stones already formed. Therefore patients with calculi and pyelonephritis-a complication we not infrequently encounter-were rendered stone-free surgically in order to maximize chances for eradicating infection with selected antibiotics. Our success in dissolving stones in each of these four patients has led us now to be more conservative in recommending operation to patients with nephrolithiasis complicated by pyelonephritis. So far we have not encountered any patient whose stones proved refractory to dissolution when D-pen. was added to the conventional programme. Over the last two years five of our patients have decided, quite against our advice, to omit fluids, alkali, and methionine restriction and to continue only on D-pen. All have remained stone-free. Because n-pen. is thought to suppress cystine most successfully in an alkaline urine we have been hesitant previously to acidify the urine of patients infected with Proteus vulgaris or patients in whom long-term suppressive therapy with Mandelamine was indicated. Our experience in Case 2 indicates that high-acidity of the urine does not interfere with the action of n-pen. Our plan with this patient is to dissolve the stones completely and then attempt a cure of pyelonephritis with appropriate antibiotics. Summary Significant stone dissolution occurred in four patients with cystine calculi when D-penicillamine was added to a previously ineffective conventional therapeutic programme of forced fluids, alkali, and in three cases methionine restriction. Elective surgery for refractory nephrolithiasis complicated by pyelonephritis should be deferred until a reasonable trial has been made to effect stone dissolution with D-penicillamine. D-Penicillamine is a highly effective therapeutic agent in cystinuria even when used alone in the absence of the conventional programme. Sporadic cases have been reported from time to time of non-specific ulceration of the small intestine presenting as intestinal obstruction, perforation, or haemorrhage. Recently it has become recognized that a stenosing ulcer of the small intestine may develop as a rare complication of medication with enteric-coated diuretic and potassium chloride tablets. We report six further cases. All our patients had been taking Hydrosaluric-K (enteric-coated hydrochlorothiazide with potassium chloride). One patient …