Vol. 60, 1909 - University of North Carolina at Chapel Hill

236 THE CHARLOTTE MEDICAL JOURNAL.
pulse was 160 and temperature 105 3-5° F. records two cases where the condition oc-
Urinalysis. Specimens of urine obtained curred in operations for torsion of the pediafter
operation were dark in color, high in cle of ovarian cysts, and two cases of stran-
specific gravity, acid, and showed the pres- gulated hernia of the omentum. His stateence
albumin, acetone, diacetic acid and ment is not sustained by facts.
bile, with granular casts. Syinpioms. The onset usually arises from
Acidosis following Chloroform Narcosis twenty-four to forty-eight hours after anes-
is the result of a perverted metabolism, due thesia, in my case the onset was within five
to a lack of oxidation of the fats and pro- hours, which was unusually early. Willteids,
resulting in the accumulation of an iams and Becker" report a case in which
abnormal amount of the acetone bodies; symptoms commenced on the fourth day,
viz: B-Oxybuturic acid, diacetic acid and and Hysett' one, one hundred and fifty
acetone in the blood. This excess of acid hours after operation.
bodies is due mainly to an excess produc- The first symptom noticed is a feeling oft
tion and only partly to diminished excre- distress followed shortly by burning" in i
tion. The symptoms do not depend so much stomach and throat, incessant nausea""and I;
upon the acetone as its precursors. In nor- emesis every half hour or so. The vomitus '
mal mjtabjlisiu B oxybuturic, by oxida- at first being clear and yellowish, later contion,
is changed into diacetic acid and the taining blood in the form of coffee-ground 1'
latter into acetone. particles. Jaundice usually appears on the
B-oxybuturic acid: CHo -CHOfI - CH., second day, first noticed on the conjunc- ,
i
-COOH. tivae, later the skin and usually becomes
Diacetic acid j CMCO - CH, -COOH intense. About the second day nervous 5
Acetone : CHu -CO CH>. symptoms appear and become pronounced;
But as a result of the perversion of meta- great restlessness, twitching of muscles of
holism there is not the complete change of face, delirium, stupor and coma. And iu
B-ovybuturic acid and diacetic acid into the fatal cases, just before death, convulacetone.
sions—the "Epilepsia Acetonica'of Von.'
Why chloroform should cause this acido- Jackson\
sis there is a^great difference of opinion.
Van Noorden' does not believe it to be due
to the chloroform but to the withdrawal of
The pulse is increased in frequency and
in severe cases becomes as rapid as i60 to
170 per minute.
carbo-hydrate diet before operation, and he
states that acidosis only occurs in those
cases which have been upon a starvation
diet free from carbo-hydrate for several
days previous to operation. This, while
true in my case is hardly tenable for the
reason that it is not true in all of the cases
reported, and again if it was true, this aci-
The temperature usually remains around ,
100° F. until just before death when it
reaches 105° F. and often higher,
The urine is scanty in amount, dark in
color, of a high^specific gravity. acid in reac-
tion, and contains acetone, diacetic acid,
B-oxybuturic acid, albumen, ibile and gran-
ular casts.
dosis should follow all forms of anesthesia
and not chloroform alone. He bases his
statement upon the experiments of fiirchfield-
who found tliat in healthy and fasting
subjects the appearance of acetone bodies
in the urine was due to the removal of carbohydrate
ftom the diet. While this may be
the cause of other varieties of acidosis it is
not of that which follows chloroform anesthesia.
It however is a contributory cause
undoubtedly.
Young and Williams'* believe the acido-
Patholosry. Howland and Richards'' in
their experiments on dogs, found that the
first changes are fatty ones in the interme-
diary zones of the liver followed by a ne-
crosis: which also extend to the center of
the lobules, so that all the cells of the liver
become necrotic. They also found hemor-
rhage extravasation in the liver substance,
The omentum and mesentery also showed
fat necrosis. The raucous membranes of
the gastro-intestinal tract were congested as
also was the serous membranes,
sis to be due to some disturbance of the Wells'" in the autopsy of his case found ^
gastro-entenc tract or sepsis. the liver to be reduced in size, flabby and i
The most satisfactory explanation is that yellow. Microscopically the centres of the
of Well in which he states that chlor6form lobules showed necrosis, the periphery fatty '
has a peculiar affinity for the protoplasm of degeneration. Williams and Becker' ''found
the hver cells, destroying the oxidizing the same liver changes—there being no
enzynesof the liver cells and not inhibiting pathological lesions in the kidneys, "panthe
autoly tic enzymes and lipase of the creas, adrenals or spleen.
*^^|i?- rrealmcnt. The treatment of this condi"
bippel seems to think the condition to tion can be discussed under the usual heads
be due to toxines which results from altered of prophylactic and curative,
circulation, and to support his statement The prophylactic methods are the import-
I