A note on the use of ammonium chloride in gastric tetany

Abstract

Studies of the experimental tetany produced by pyloric obstruction made by MacCallum 2 showed clearly a reduction in plasma chloride and a coincident increase in the CO₂ combining power of the blood plasma. A publication of a similar nature 3 called attention to this latter feature, but not to the reduction of plasma chloride content. The priority in experiments clearly belongs to MacCallum. Both reports agree in the interpretation that the primary disturbance is due to a loss of chloride through the gastric secretions. The therapeutic results obtained in experimental animals by replacing chloride ions either by injection of NaCl intravenously, 2 or HCl into the duodenum, 3 were good.

More recently attention has been called by Haldane 4 to the effects of administration of ammonium chloride by mouth. This substance when ingested produces an acidosis resulting in lowered CO₂ combining power of plasma, and an increased excretion of acid. The most probable explanation is that the ammonia is rapidly converted into urea leaving HCl 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 carcinorn a. C holecystectomy 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.