METABOLIC BALANCE INVESTIGATION OF THREE CASES OF MULTIPLE MYELOMA DURING ACTH ADMINISTRATION; EXCHANGES OF CALCIUM, PHOSPHORUS, NITROGEN AND ELECTROLYTES 1
Authors: William S. Adams, Earl D. Mason, Samuel H. Bassett
Journal: Journal of Clinical Investigation (1954)

The patients were admitted to the Metabolism Ward where they were under continuous observation.The urine was analyzed daily for sodium, potassium, phos- phorus, chloride, and nitrogen; aliquots of the 24-hour collections of urine were saved and pooled in periods of five days, and the analyses repeated on the pooled sam- ples.This served as an added check on the accuracy of the daily work.Stools were separated at intervals of five days with the use of carmine markers and analyzed for the same constituents as in the case of urine.Sample diets, duplicating the menus of the patients, were prepared at intervals of ten days, homogenized, sampled, and analyzed to determine intake.Emeses and dietary re- jects were treated in the same manner as sample diets, analyzed separately, and appropriate corrections of in- take were made.Blood was collected in the postabsorptive state from an arm vein with the least possible stasis, and after prompt separation of the serum, determinations were made of total serum protein, albumin, globulin, so- dium, chloride, potassium, calcium, and phosphorus.The analytical methods used were as follows: Aliquots of diet, urine, and emesis were ashed in a muffle furnace at a temperature not exceeding 4500 C. Sodium and po- tassium determinations were performed directly on di- luted specimens of urine and (blood) serum, with the use of the Beckman flame photometer.With the excep- tion of nitrogen and chloride, the other substances were determined from the ashed filtrates.Urinary, fecal, and dietary calcium were determined by the gravimetric method of Washburn and Shear (12), serum calcium by the method of Van Slyke and Sendroy (13), phosphorus by the gravimetric method of Washburn and Shear (12), and a modification of the colorimetric method of Fiske and Subbarow (14), nitrogen by the Hiller, Plazin, and Van Slyke modifications of the Kjeldahl procedure (15), chlorides by modification of the Volhard method (16-18), plasma proteins by a modification of the Howe sodium sulfate method (19) as described by Majoor (20), and urinary protein by the method of Hiller, Greif, and Beck- man (21), serum and urine uric acid by modification of the methods of Kalckar ( 22) and Praetorius (23).103 * Grams protein per five-day period.metabolic unit for studies which were continued for 75 Patient 3 (S.M.) (See Figures 8-13 and Tables II, III, days.During 50 days of this time he received a course V-VII.) of ACTH which resulted in marked subjective improve-S.M., a white male of 58 years, entered the hospital in ment, although in no sense did it eradicate signs of the March 1949 with a six-month history of pain in the back disease.Approximately one year later he developed a and shoulders, weakness of and loss of sensation in the sudden paraplegia, "cord" bladder, and fecal incontinence.lower extremities.He had been confined to bed for the Cortisone therapy was tried but he became progressively month prior to admission because of inability to move his worse and died in August, 1951.The diagnosis of multi-legs.On examination, he was found to have a spastic ple myeloma was confirmed at autopsy.paraplegia, diminution of sense of pain and touch over TABLE III Urinary calcium Case J. D. Case J. M. Case S. M. * Grams calcium per five-day period.