Discussion of Session on Organ System Involvement in Uremia

Arch Intern Med. 1970;126(5):801-807. doi:10.1001/archinte.1970.00310110071009.
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Louis G. Welt, MD: The floor is now open for questions.

Douglas A. K. Black, MD: My question is addressed to Dr. Tyler and concerns the syndrome he delineated which is characterized by a convulsion with a considerable tonic, but negligible clonic component, which was liable to be followed by sudden death from a cardiac arrhythmia. Realizing the difficulties of studying such a syndrome, I would like to ask whether he knows of any electrolyte correlates of this syndrome.

H. Richard Tyler, MD: It's obviously very difficult to make clinical observations in situations like this. I became aware of this syndrome when I went to the record room of our hospital and looked up all the patients with kidney disease who had had convulsions. The first thing that interested me was that 25% of these patients had been considered terminal prior to their convulsive episode. The usual description of their


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