A study of nitrogen metabolism in a case presenting short paroxysms of fever of unknown origin

Abstract

The patient upon whom these studies were made presented an unusual paroxysmal syndrome probably toxemic in origin, characterized by attacks of prostration, pain — chiefly abdominal — fever, tachycardia and polynuclear leucocytosis, with some nausea and vomiting, lasting twenty four to forty eight hours. The case was reported by us to the Association of American Physicians, May 12. A study of the urinary nitrogen was made November 6 to December 2,‘07, and April 7 to May 5,‘08, embracing three attacks during the first period and two during the second. Urea and ammonia nitrogen did not vary beyond normal limits. The chief interest centered in the uric acid and creatinin output. During the latter part of the first period the uric acid, on a uniform purin-free diet of 2,350 calories for a girl of 47.3 kilos, showed a distinct fall before the last attack, with a subsequent rise. During the second period the patient was kept on a creatin and purin-free diet unrestricted as to quantity, the amounts of creatinin and uric acid rising sharply after each attack, the latter showing a fall before the attack. Throughout the whole period the uric acid showed as wide variations as Kaufman and Mohr, and von Noorden and Schliep, described in the subjects of true gout. A test of her tolerance for exogenous purins, however, showed that her elimination of uric acid after eating 580 grams of beef was even higher than Burian and Schur's normal figure of 50 per cent. The creatinin was also wholly eliminated. Comparison of the eliminations during these two days with those in the urine after the attacks shows that, in the latter urines, she excreted as much additional uric acid and creatinin as might be derived from 580 grams of beef, with a nitrogen loss of 10 grams after the first attack and 13 grams after the second.