STUDIES ON THE RELATIONSHIP BETWEEN OXYGEN CONSUMPTION AND NITROGEN METABOLISM. I. IN PERNICIOUS ANEMIA
Authors: C. W. Baldridge, Adelaide Barer
Journal: Journal of Clinical Investigation (1931)

In this communication we are reporting the first of a series of metabolic studies in certain diseases in which there is an altered rate of oxygen consumption without a recognized disturbance in thyroid function.We wish particularly to stress a correlation between oxygen consumption and protein metabolism.Data obtained by a study of six patients with pernicious anemia are presented and discussed.Many metabolic studies have been made in pernicious anemia.Some of the factors which were most disturbing in the earlier work are now controllable.We refer to the fact that remissions in the- disease can be brought about rapidly and consistently by therapeutic measures and such remissions can be recognized early by means of the reticulocyte crisis.Our primary concern has been to determine and to explain, if possible, the variations in oxygen consumption during relapses, reticulocyte crises, and regenerative periods in pernicious.anemia. REVIEW OF LITERATUREObservations on the oxygen consumption in patients with pernicious, anemia are quite numerous in the literature.The earlier reports were, for the most part, only single basal metabolic rates which were normal or moderately increased.Such observations were made by Meyer and DuBois (1), Tompkins, Brittingham and Drinker (2), Grafe (3), and Boothby and Sandiford (4).Meyer and DuBois suggested that the oxygen consumption was increased in severe anemia.Later some investigators made repeated examinations on the same patient, and learned that the oxygen consumption usually decreased as the blood count increased.Among these observers were Becker (5), Richards and Strauss (6), Alt (7), and Grassheim (8).Previous to '1926, studies on nitrogen metabolism in pernicious anemia 529 PERNICIOUS ANEMIA gave conflicting results.Some patients would show nitrogen retention and others nitrogen loss, and occasionally a shift from negative to positive nitro- gen balance would occur in a patient while under observation.It was demonstrated that the nitrogen balance was not necessarily dependent upon the hemoglobin content of the blood or the protein intake.Studies were made before and after splenectomy and considerable effort was made to determine the proportion of nitrogen eliminated as urea and uric acid, but in many instances it is not possible now to tell whether the disease was in a regenerating or a relapsing phase when these observations were made.Gibson and Howard ( 9) obtained nitrogen retention by giving a diet (10) -containing fifty grams of liver per diem.Alt recently showed that theCase 1, L. M., female, aged 46 years.The total period of observation was 103 days.Determinations were made daily for 34 days, once during the sixth week and tni-weekly thereafter except that the basal metabolic rate was not done on the fifth day and no observations were made between the eighty-sixth and ninety-eighth days.Erythrocyte counts were made frequently.The treatment consisted of 4 cc. of dilute hydrochloric acid with each meal and three vials of Lilly's liver extract daily, beginning after a control period of 9 days.General hospital diet was given for the first 36 days and high caloric general diet for the succeeding 67 days.The body weight increased from 53.0 kgm. to 63.5 kgm.During the period 57 determinations of the basal metabolic rate were made with duplicate gas analyses.Case I-L.M. Control period ... .9 98.8 .1184.5 1.2 19.9 .723.00636.3 .4Reticulocyte crisis ... .20 98.5 .08 83.1 0.8 20.0 .730.00438.1 .2Regeneration period.... 74 98.2 .0485.1 0.7 20.0 .740.00537.2 .1 Case II-L.D. Control period .. 9 98.5 .1884.4 1.2 19.8 .785.01036.0 .5 Reticulocyte crisis ... 19 98.1 .08 78.1 1.0 19.5 .812.006 34.4 .3Regeneration period.... 75 97.7 .0581.5 0.5 19.6 .810.00534.1 .3Case III-M.M. Control period . . . . 3 100.0.1996.4 3.0 21.1 .732.00541.9 .3Reticulocyte crisis ... . 20 99