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February, 1945 RICE DIET—KEMPNER 63 It is not unusual for the weight to decrease more or less markedly during the first twenty days. The reason for this weight loss may be that the amount of food given does not cover the caloric requirements; in such cases, the amount of food must be increased, unless reduction of weight is indicated. Another reason may be that the patient does not eat the full amount of his diet during the first period of adjustment. The most frequent cause is the loss of visible or invisible edema; one patient with marked edema, for example, lost 63 pounds within the first sixteen days on the diet. During the first few weeks of the rice regime hospitalization greatly facilitates the study and treatment of the patient, but rest in bed, unless the severity of the disease demands it, is neither necessary nor desirable. A great number of patients on the rice diet have experienced marked relief from giddiness, headache, mental sluggishness and depression, and easy fatigability. Such subjective improvement has not been accepted as evidence of successful therapy; only objective results, such as loss of edema and changes in urine and blood chemistry findings, in blood pressure, eyegrounds, heart size, and electrocardiograms, have been used to determine the effect of the treatment. For some of the patients who had shown satisfactory improvement, the diet, after a time, was modified by the addition of non-leguminous vegetables or small amounts of potatoes, lean beef, chicken, fish, or eggs (everything prepared without salt or fat). This was usually done on the insistence of the patient. It must be borne in mind, however, that even these slight modifications change the character of the diet and may spoil the entire effect. Where a critical condition of kidney, heart or retina exists, any compromise may be too much, and the patient may have to pay for the few exceptions made with the reappearance of all the signs and symptoms of the disease. In such cases, the strict diet should be continued indefinitely, just as liver is continued in pernicious anemia and insulin in diabetes. It must, however, be emphasized that even in the less serious cases the "modified" rice diet, though still preferable to other diets of low protein, fat and salt content, cannot replace in effectiveness the strict rice diet and should be used with caution. Each patient, preferably while in the hospital, should be individually "regulated" on the modified diet by being allowed only so much additional food as he can take without reacting unfavorably with changes in blood pressure, heart size, electrocardiogram, nonprotein nitrogen, and so forth. This will be further illustrated in the case histories and charts. The diet was used in the treatment of 213 patients in whom insufficiency of the metabolic function of the kidney either was evident or could not be ruled out. Eighty-three patients had "primary" kidney disease (7 patients acute glomerulonephritis, 73 chronic glomerulonephritis, chronic pyelonephritis, or nephrolithiasis, 2 lupus erythematosus, and 1 polycystic kidney disease). One hundred and thirty patients were listed under the diagnosis of "hypertensive vascular disease"; 67 of them showed no conclusive evidence of renal excretory dysfunction, 63 had definite "secondary" kidney involvement— that is, one or several of the following findings: phenolsulfonphthalein excretion in two hours below 50 per cent, urea clearance below 50 per cent, nonprotein nitrogen above 40 mg. per 100 cc. of blood, more than 0.8 Gm. of albumin per 1000 cc. of urine, range in specific gravity (concentration-dilution test) of less than 0.012, 5 red blood cells or 3 granular casts per high power field. The diet was used for periods varying from four days to thirty-two months; after two to five months some of the modifications listed were permitted in most cases. The diet has been ineffective in 75 of the 213 patients treated (35 per cent), if we judge according to rigid standards and include 27 patients who were in a critical condition when started on the diet and who died after an average period of twenty-five days. In 138 of the 213 patients (65 per cent) the diet has proved to be beneficial. In no instance has it been harmful; careful medical supervision, however, including control of blood and urine chemistry, is essential. Protein Requirements of Patients on Rice Diet We were afraid that the small amount of protein contained in the rice diet would lead to a depletion of the plasma proteins and to a decrease in hemoglobin; but we were willing to take these risks, since we thought that such deficiencies could be corrected at some later stage after the imminent danger of uremic or cardiac death or of blindness had been overcome. The determinations,
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1945 |
Identifier | NCHH-17-006 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 6 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-006.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-006 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Description
Fixed Title * | Page 63 |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1945 |
Identifier | NCHH-17-006-0075 |
Form General | Periodicals |
Page Type | all; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed61945medi_0075.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 6 |
Issue Number | 2 |
Page Number | 63 |
Health Discipline | Medicine |
Full Text | February, 1945 RICE DIET—KEMPNER 63 It is not unusual for the weight to decrease more or less markedly during the first twenty days. The reason for this weight loss may be that the amount of food given does not cover the caloric requirements; in such cases, the amount of food must be increased, unless reduction of weight is indicated. Another reason may be that the patient does not eat the full amount of his diet during the first period of adjustment. The most frequent cause is the loss of visible or invisible edema; one patient with marked edema, for example, lost 63 pounds within the first sixteen days on the diet. During the first few weeks of the rice regime hospitalization greatly facilitates the study and treatment of the patient, but rest in bed, unless the severity of the disease demands it, is neither necessary nor desirable. A great number of patients on the rice diet have experienced marked relief from giddiness, headache, mental sluggishness and depression, and easy fatigability. Such subjective improvement has not been accepted as evidence of successful therapy; only objective results, such as loss of edema and changes in urine and blood chemistry findings, in blood pressure, eyegrounds, heart size, and electrocardiograms, have been used to determine the effect of the treatment. For some of the patients who had shown satisfactory improvement, the diet, after a time, was modified by the addition of non-leguminous vegetables or small amounts of potatoes, lean beef, chicken, fish, or eggs (everything prepared without salt or fat). This was usually done on the insistence of the patient. It must be borne in mind, however, that even these slight modifications change the character of the diet and may spoil the entire effect. Where a critical condition of kidney, heart or retina exists, any compromise may be too much, and the patient may have to pay for the few exceptions made with the reappearance of all the signs and symptoms of the disease. In such cases, the strict diet should be continued indefinitely, just as liver is continued in pernicious anemia and insulin in diabetes. It must, however, be emphasized that even in the less serious cases the "modified" rice diet, though still preferable to other diets of low protein, fat and salt content, cannot replace in effectiveness the strict rice diet and should be used with caution. Each patient, preferably while in the hospital, should be individually "regulated" on the modified diet by being allowed only so much additional food as he can take without reacting unfavorably with changes in blood pressure, heart size, electrocardiogram, nonprotein nitrogen, and so forth. This will be further illustrated in the case histories and charts. The diet was used in the treatment of 213 patients in whom insufficiency of the metabolic function of the kidney either was evident or could not be ruled out. Eighty-three patients had "primary" kidney disease (7 patients acute glomerulonephritis, 73 chronic glomerulonephritis, chronic pyelonephritis, or nephrolithiasis, 2 lupus erythematosus, and 1 polycystic kidney disease). One hundred and thirty patients were listed under the diagnosis of "hypertensive vascular disease"; 67 of them showed no conclusive evidence of renal excretory dysfunction, 63 had definite "secondary" kidney involvement— that is, one or several of the following findings: phenolsulfonphthalein excretion in two hours below 50 per cent, urea clearance below 50 per cent, nonprotein nitrogen above 40 mg. per 100 cc. of blood, more than 0.8 Gm. of albumin per 1000 cc. of urine, range in specific gravity (concentration-dilution test) of less than 0.012, 5 red blood cells or 3 granular casts per high power field. The diet was used for periods varying from four days to thirty-two months; after two to five months some of the modifications listed were permitted in most cases. The diet has been ineffective in 75 of the 213 patients treated (35 per cent), if we judge according to rigid standards and include 27 patients who were in a critical condition when started on the diet and who died after an average period of twenty-five days. In 138 of the 213 patients (65 per cent) the diet has proved to be beneficial. In no instance has it been harmful; careful medical supervision, however, including control of blood and urine chemistry, is essential. Protein Requirements of Patients on Rice Diet We were afraid that the small amount of protein contained in the rice diet would lead to a depletion of the plasma proteins and to a decrease in hemoglobin; but we were willing to take these risks, since we thought that such deficiencies could be corrected at some later stage after the imminent danger of uremic or cardiac death or of blindness had been overcome. The determinations, |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-006.pdf |
Document Sort | all; nchh-17 |
Article Title | Compensation Of Renal Metabolic Dysfunction |
Article Author | Walter Kempner |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-006 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
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