Effect of Ammonium Chloride Administration on Metabolism in Infantile Tetany and Rickets

Morris, Noah; Macrae, Olive

doi:10.1136/adc.7.37.47

Archives of Disease in Childhood

1932

DOI: 10.1136/adc.7.37.47

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Effect of Ammonium Chloride Administration on Metabolism in Infantile Tetany and Rickets

Noah Morris¹,

Olive Macrae²

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1935

1937

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The Effect of the Acid-Base Content of the Diet Upon the Production and Cure of Rickets with Special Reference to Citrates

Shohl

1937

The Journal of Nutrition

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The question of the acid-base factor in the etiology and pathogenesis of rickets is one that has long excited interest. The experimental results have, however, been conflicting and the controversial discussions have failed to clarify the situa tion. Summaries of the earlier work have been given by Shelling ('25), Hess ('29), GyÃ ¶rgy ('29) and Goldblatt ('31) and in our earlier papers (Shohl et al., '28, Shohl et al., '32). That rickets is associated with an acid metabolism and tetany with an alkaline, has been strongly advocated by Freudenberg and GyÃ ¶rgy ('22). The role of acidosis in the pathogenesis of rickets has recently been reviewed by Morris, Ford and Graham ('36) who could find no evidence that acidosis was "either a causal or associated factor in infantile rickets." The acid-base equilibrium of the blood shows little or no variation from the normal in either clinical rickets or infantile tetany, or, except in special cases, in experimental rickets (Shohl et al., '31). Therefore, efforts to show changes in metabolism have been directed toward studies of the ex cretion of acid and ammonia in the urine. With regard to the effect of ingestion of acid our previous experiments have tended to confirm GyÃ ¶rgy's thesis, with 69

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The Effect of the Acid-Base Content of the Diet Upon the Production and Cure of Rickets with Special Reference to Citrates

Shohl

1937

The Journal of Nutrition

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The Rôle of Acidosis and Phosphate Retention in the Pathogenesis of Rickets and Rachitic Tetany of Infants.

1935

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Summary. There is no evidence that acidosis is either a causal or associated factor in infantile rickets. There is an increased urinary output of ammonia but the fact that it is associated with a diminution in the titratable acidity of the urine renders it unlikely that there is a condition of acidosis present. This conclusion is further strengthened by the fact that healing of rickets as evidenced by increased retention of minerals and X‐ray signs, may take place during prolonged administration of an acid‐producing substance. Infantile tetany is characterised by an increased retention of chlorine but there is no evidence of any disturbance of acid‐base equilibrium as a causal or associated factor. The retentions of calcium and phosphorus may run parallel even in the presence of tetany. Furthermore the phosphorus retention may be proportionately greater than that of calcium during spontaneous healing or following vitamin D therapy without any manifestations of tetany. Even the administration of large doses of phosphate leading to a great increase in the retention of phosphorus with a diminution in that of lime does not necessarily lead to the appearence of tetany although the calcium stores of the body have been previously greatly depleted. These results indicate that tetany complicating rickets may occur without an excessive retention of phosphorus over calcium and that excessive retention of phosphorus may take place without any manifestation of tetany. It therefore seems justifiable to conclude that phosphate retention is not the dominating factor in the pathogenesis of infantile tetany. The authors are indebted to Prof. G. B. Fleming for much helpful advice. They desire to express their thanks to the Medical Research Council for personal grants to two of them (S. G. and N. M.)

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Effect of Ammonium Chloride Administration on Metabolism in Infantile Tetany and Rickets

Cited by 2 publications

References 1 publication

The Effect of the Acid-Base Content of the Diet Upon the Production and Cure of Rickets with Special Reference to Citrates

The Effect of the Acid-Base Content of the Diet Upon the Production and Cure of Rickets with Special Reference to Citrates

The Rôle of Acidosis and Phosphate Retention in the Pathogenesis of Rickets and Rachitic Tetany of Infants.

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