394 



Scientific Proceedings (124). 



rapidly converted into urea leaving HC1 to combine with other 

 bases. 



In view of these facts it was determined to apply ammonium 

 chloride to the treatment of gastric tetany. The opportunity 

 presented itself in the case of Mrs. Helen G., aged 59 years, who 

 had entered the hospital with a history of vomiting frequently for 

 two years, and especially frequently during the preceding three 

 months. An annular filling defect was noted in roentgenograms 

 which was thought to be the result of carcinoma. A laparotomy 

 performed revealed no evidence of carcinoma. Cholecystectomy 

 was done for cholelithiasis. After operation vomiting continued. 

 Five days later the typical carpopedal spasms of tetany were 

 noted. A positive Trousseau's sign was obtained. Blood was 

 taken for examination at this time. The patient was given an 

 intravenous injection of 500 c.c. of an 0.822 per cent, solution of 

 ammonium chloride, P H 7.0, which has been tested against the 

 patient's blood and found to cause no hemolysis. Carpopedal 

 spasms ceased during the injection and no return of tetany was 

 noted up to the time of death twelve days later. The table shows 

 the resulting changes in blood constituents. 







Chlorides 



Non-Prot. 



Serum 





CO2 CP. 



Whole Blood 



Nitrogen 



Calcium 



Date. 



Volume 



Mgs. 



Mgs. 



Mgs. 





Per Cent. 



per 100 c.c. 



per 100 c.c. 



per 100 c.c. 



4-13 before treatment .... 



75-7 



386 



30.6 



8.8 



4-13 \ hr. after treatment 



53-0 









4-14 



63.5 



455 



34-9 





4-21 



58.2 



484 







4-23 





478 



36.4 





Saline infusions were started after the second blood specimen 

 was withdrawn, and continued daily until the 20th. 



At autopsy there was found to be a diaphragmatic hernia con- 

 taining the fundus of the stomach and producing a marked con- 

 striction. The esophagus entered so that practically only the 

 fundus filled with food or bismuth. 



Mention should be made of the recent successful use of ammo- 

 nium chloride in the treatment of tetany in children. 1 



1 Freudenberg and Gyorgy, Klin. Wochenschr., 1922, 1, 411. 



