High Intestinal Obstruction In the Dog Treated with Extract of Adrenal Cortex

Abstract

Acute intestinal obstruction as a representative of a group of conditions that are characterized by hyperazotemia and hypochlo-remia bears resemblance to adrenal insufficiency. 1 , 2 , 3 Indeed, we described the histologic1 changes of the adrenal glands in the dog with high intestinal obstruction as that of lipoid exhaustion of extreme degeneration of the adrenal cortex.∗

In view of Kendall 5 separation of 2 fractions of the cortical extract one of which produces results only when salt is administered with it, it seemed desirable to study the combined effect of cortical extract and salt solution in high intestinal obstruction. The amount of salt solution employed was considerably less than previously found sufficient to prevent adrenal exhaustion.

High intestinal obstruction was induced on 6 dogs. The method, the preoperative and postoperative care were the same, as employed previously. 1 Daily blood studies were made for NaCl, urea nitrogen, CO₂ combining power of blood plasma, hemoglobin specific gravity and red blood cell count.

Two dogs received 200 cc. of physiological salt solution intraperi-toneally on the day of operation and every day thereafter plus 3 cc. of adrenal cortex extract intramuscularly; 2 dogs had neither cortin, nor salt solution; 2 dogs received daily intramuscular injections of 3 cc. of extract of adrenal cortex.† The dogs receiving adrenal cortex and salt solution lived for 15 days, when they were anesthetized and killed. They showed a loss of weight of 1.3 kilos and towards the last 2 days developed twitchings of muscles of hind legs. The blood urea nitrogen rose from 9.8 mg. % on the day of operation to 21 mg. % on the day of postmortem. The blood chlorides decreased from 510 mg. % to 420 mg. %. The CO₂ increased from an initial 48.5 volume % to 75.3 volume %. The specific gravity remained practically the same. (1.028 to 1.030). The hemoglobin decreased from 14 gm. to 10.5 gm. The red blood cells decreased by 1,470,000. The postmortem and histological findings of the organs as well as those in other dogs will be described elsewhere. 6 The dogs without salt solution and cortin lived 5 days. They became toxic; vomited on the second day after operation, gradually grew worse and died on the fifth day after operation. The blood urea nitrogen increased from 16.1 mg. % on the day of operation to 144.2 mg. % on the day of death. The blood chlorides decreased from 440 mg. % to 302 mg. %. The specific gravity of the blood increased from 1.025 to 1.043. The hemoglobin has increased from 8.5 gm. to 17 gm. The red blood cells increased by 1,410,000.

The dogs receiving cortin alone lived for 7 days. They lost one kilogram in weight; they apparently were not toxic and on the seventh day developed twitchings of muscles of trunk and of all 4 extremities and died. On this day, an additional dose of 3 cc. of cortin was given without much benefit. The blood changes were as follows : The blood urea nitrogen increased from an initial 14.7 mg. % to 66.5 mg. % on the day of their death; the blood chlorides decreased from 480 mg. % to 260 mg. %. The CO₂ increased from 48.1 vol. % to 78.2 vol. %. The specific gravity increased from 1.027 to 1.030; the hemoglobin decreased from 14 gm. to 11 gm., and the red blood cells decreased by 1,300,000.

Heuer and Andrus 7 prolonged the lives of dogs receiving intravenous injections of aqueous extracts of closed intestinal loops by administering cortical extract combined with transfusion. Scudder, Zwemer and Truszkowski 8 fortified our comparison between the clinical and biological picture of acute intestinal obstruction and adrenal insufficiency by demonstrating high blood potassium values in cats with high intestinal obstruction. This assumes special importance in view of Zwemer's and Truszkowski's 9 findings that symptoms of adrenal insufficiency may be explained in terms of a disturbance of cortico-adrenal-potassium interrelation.

We appreciate that our experiments are too few in number to permit the drawing of definite conclusions, but one would seem justified in emphasizing: 1. The many features in common in acute intestinal obstruction and adrenal insufficiency. 2. The apparent benefit from the combined administration of physiological salt solution and adrenal cortex extracts in combating the toxemia of high intestinal obstruction.