AZOTURIA— PARALYTIC HEMOGLOBINURIA 201 



appear. If nephritis complicates the case, large quantities of 

 albumin appear in the urine and uremic spasms and loss of 

 consciousness follow. 



The blood coagulates readily but the clot is not firm and 

 the serum limited. The serum is usually red stained. The 

 quantity of hemoglobin present varies greatly. After the 

 sweating has subsided and the patient has begun to drink 

 freely it will be found slightly below normal. The specific 

 gravity of the blood is normal and the number of red cor- 

 puscles somewhat reduced. 



Complications. — (a) Decubital gangrene which may cause 

 a general infection; (b) hypostatic congestion or even inflam- 

 mation of the lungs; (c) uremia following, nephritis; {d) 

 fracture especially of the pelvis and limb from falling during 

 the disease. 



Course. — In mild cases where the patient retains its feet, 

 the duration may be very short, lasting but one or two hours. 

 Severe cases usually continue for two to three days when the 

 patient begins rapidly to improve or becomes worse and dies. 

 While death may occur on the first to third day, the patient 

 usually lives a week. General infection is the commonest 

 cause of death. In some cases a paralysis of the quadriceps 

 femoris, adductors or crurals are sequels which may delay 

 complete recovery for several months. A given patient may 

 suffer repeated attacks of azoturia within a few weeks or 

 months. 



Diagnosis. — The cardinal symptoms of azoturia are: 1. 

 The muscular paralysis, and 2. the dark-colored urine. The 

 history of the patient should also be taken into consideration. 

 The following diseases and conditions resemble it: (a) Colic. 

 Confusion with colic would be excusable only in the early 

 stages of the attack. There is neither paralysis nor hemo- 

 globinuria in colic. 



(b) Injury to the spinal cord. Here the paralysis is com- 

 plete behind the lesion; the tail, sphincters, bladder and 

 rectima are also paralyzed. The skin posterior to the injury 

 is not sensitive to pin-pricks. There is no hemoglobinuria. 



(c) Fractures of the pelvis and posterior limb bones may 

 sometimes simulate azoturia. This is also true of rupture of 



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