346 HERMAN O. MOSENTHAL 



Mineral Metabolism in Nephritis 



The Chlorids of the Blood in Nephritis. The observations on the 

 chlorid content of the blood have thus far defied satisfactory interpreta- 

 tion. This is due in part to the fact that insufficient attention has been 

 paid to the medium whole blood, plasma or serum in which the chlorid 

 content was determined. The normal sodium chlorid concentration in 

 whole blood is 4.5 to 5.0 grams per liter, while that in the plasma is 1.2 

 grams higher. If the blood is allowed to stand the salt in the plasma 

 increases due to a loss of carbon dioxid from the plasma, and a consequent 

 shift of sodium chlorid from the corpuscles to the plasma. On this account 

 it would appear that chlorid determinations on the plasma cannot be re- 

 garded as very accurate and that many of the observations will have to 

 be repeated with whole blood (for full discussion see section on normal 

 tissues). 



McLean (a) found the lowest plasma chlorid in his series in a diabetic 

 patient : 5.0 grams per liter, and the highest, 8.4 grams, in a cardione- 

 phritic case just before death. Host showed how the chlorids in the blood 

 may drop in acute nephritis as the edema diminishes and the kidneys 

 eliminate increased amounts of water and sodium chlorid. The blood 

 chlorids in his cases while edema existed were respectively 5.8, 5.5, 5.1, 5.2 

 grams per liter; after the subsidence of the edema the values dropped to 

 4.5, 4.7, 4.6, and 4.5 gm. Austin and Jonas have confirmed the occurrence 

 of such low figures. They found the plasma chlorids as low as 4.6 gm. per 

 liter in one case of advanced glomerulonephritis 5 days before death. 

 Atchley's observations in acute nephritis bear out Host's results. 



However, Atchley had one case which was rather confusing in the light 

 of the above findings. The results in this patient go far to show that the 

 blood chlcrids are not controlled by one factor but by many. In one 

 of his observations the plasma chlorids dropped from 6.19 to 4.45 grams 

 per liter during a period of practical suppression of urinary chlorid ex- 

 cretion ; Atchley offers two possible explanations of this phenomenon : 

 first, that the chlorids may have been forced into the corpuscles by a change 

 in the carbonate concentrations, the Zunst reaction; second, that an in- 

 crease in the other blood constituents such as urea may demand an ad- 

 justment to preserve the osmotic balance. Atchley believes his case to be 

 most - important as illustrating that there may be a very great change 

 in the plasma chlorid concentration independent of intake or urinary 

 excretion and paradoxical to the apparent chlorid balance. 



Diet will certainly modify the blood chlorids to a certain extent. The 

 crudest and most telling way to effect this is to give a considerable quantity 

 of sodium chlorid by mouth. After the ingestion of 10 grams the author 

 has found a distinct rise of chlorids in the whole blood. Austin and Jonas 



