PATHOLOGICAL METABOLISM IN PREGNANCY 859 







there have been found marked changes in the urea and ammonia excretion. 

 Recent blood determinations of the carbon dioxid uniting power, represent- 

 ing the degree of acidity, would indicate that even in the presence of the 

 high ammonia in the urine, there is no lessening of the alkali reserve. The 

 amino-acid of the urine may be normal in amount in the presence of this 

 high ammonia output. These conflicting results leave no explanation for 

 the rise in ammonia unless it occurs in the bladder from bacterial action. 



However, there are on record two cases of pernicious vomiting in which 

 the blood chemistry and carbon dioxid combining power have been obtained 

 and both show a low urea coefficient with marked acidosis. The unde- 

 termined nitrogen constituent is left unexplained but there is indication 

 that it consists of amino bodies. The remarkable similarity of the blood 

 picture of pernicious vomiting and eclampsia adds confirmation to the 

 theory of the single identity of these diseases. Further blood determina- 

 tions especially of the amino-bodies are needed. 



Stadie and Van Slyke's case of acute yellow atrophy in a non-pregnant 

 woman would indicate that autolysis of this organ in vivo throws into the 

 circulation an amount of amino-acids that cannot be taken care of by the 

 tissues and hence deficient deamination becomes a fact and there results 

 an increase of these bodies in the blood and urine. 



In eclampsia the amino-acids of the blood and urine are not increased. 

 There are changes in the non-protein nitrogen, the urea, the creatinin and 

 uric acid fractions in the blood that point to an insufficiency of the liver 

 and in many cases to a secondary functional disturbance of the kidneys 

 as well. That liver degeneration may account for these changes, inde- 

 pendently of lowered kidney function, is indicated in eclampsia by changes 

 in the glycogenic, bile and lipoid functions of this organ. 



Blood chemistry is of value in separating the chronic nephritic tox- 

 emias from the true eclampsias and in either condition may present evi- 

 dence of disturbed metabolism that would indicate the necessity of empty- 

 ing the uterus. The time of operative procedure must be made dependent 

 upon the degree of acidosis as represented by the carbon dioxid combining 

 power of the blood. 



