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March, 1945 RICE DIET—KEMPNER 137 albumin 3.5 Gm., globulin 4.2 Gm., albumin-globulin ratio 0.83. Chlorides (as sodium chloride) were 574 mg. per 100 cc. of plasma; calcium was 8.7 mg. per 100 cc. of serum, phosphorus 4.2 mg., cholesterol 270 mg. The urine had a specific gravity of 1.002-1.018, and contained 1-5 red blood cells and 3-35 white blood cells per high power field, and many granular casts. The benzidine reaction was 0-1 plus. The first ten albumin determinations showed an average excretion of 1.7 Gm. per 1000 cc. The results of a phenolsulfonphthalein test were as follows: 5 per cent excretion at first half hour, 2.5 per cent at one hour, 2.5 per cent at one and a half hours, less than 2.5 per cent at two hours; total excretion in two hours less than 12.5 per cent. The test was repeated a week later and showed 10 per cent excretion at the first twenty-three minutes, 5 per cent at forty-three minutes, 5 per cent at one and a half hours, less than 2.5 per cent at two hours; total excretion in two hours 20-22.5 per cent. Impression: Chronic pyelonephritis with hypertension, vascular retinopathy, heart enlargement. Course: After five clays of strict bed rest on a diet containing 65 Gm. of protein, the blood pressure (average from the fifth to the ninth day) was 234 systolic, 144 diastolic (fig. 42). The lowest blood pressure readings during sodium amytal sleep were 190 systolic, 130 diastolic and 184 systolic, 138 diastolic. The patient complained of very intense headache every day. On the ninth hospital clay the rice diet was begun (2000 calories, fluids limited to 1500 cc., after two weeks to 1000 cc.). The blood pressure level remained almost unchanged for about three weeks. In the fourth week, first the systolic, then the diastolic pressure began to decrease gradually. After five weeks of rice diet the blood pressure average of five days was 150 systolic, 119 diastolic. The plasma chlorides (as sodium chloride) at this time were 507 mg. per 100 cc. The nonprotein nitrogen was 42 mg. per 100 cc. of blood. The albumin in the urine had decreased to an average of 0.8 Gm. per 1000 cc. The urine sediment contained a great number of white blood cells, but no red blood cells or casts. There were still numerous hemorrhages in both eyes (fig. 43). The patient was discharged on the rice diet on May 21, 1943, feeling very much better. The headaches from which she had been suffering for seven months had become much milder after two weeks of the diet and had completely disappeared after four weeks. The patient continued to follow the rice diet, to which some non-leguminous vegetables were added early in July, and was occasionally seen in the hospital. She had no headaches and no substernal oppression. Her eyesight improved markedly. The retinal hemorrhages were absorbed. The blood pressure decreased almost to normal: the average level from June 22 to July 3, 1943, was 128 systolic, 92 diastolic; from August 21 to 25, 1943, 118 systolic, 90 diastolic. The heart became smaller in size, with a change in the transverse diameter of 21 per cent (fig. 40). The total phenolsulfonphthalein excretion in two hours was 25 per cent. On October 7, 1943, the patient was readmitted because of diarrhea, anorexia, and weakness. Her blood pressure at that time was 114 systolic, 82 diastolic. The transverse diameter of the heart was 10.05 cm. (as against 11.9 cm. six months before). The electrocardiogram showed the angle of the electrical axis to be +57 degrees (as against +22 degrees six months before). The hemoglobin was 78 per cent, the nonprotein nitrogen 35 mg. per 100 cc. of blood; the chlorides (as sodium chloride) were 466 mg. per 100 cc. of serum, the total proteins 5.9 Gm. per 100 cc. of plasma (albumin 2.3 Gm., globulin 3.6 Gm.). The total nitrogen excretion in the urine was 0.94 Gm. in twenty-four hours. Sodium chloride (0.6 Gm. to 3 Gm. daily) was added to the diet during the first fourteen days. On the eighth hospital day, the temperature rose to 38.6 C. A catheterized specimen of urine was loaded with white blood cells. One and a half grams of sulfadiazine and 1.8 Gm. of sodium bicarbonate were given daily for seven days. After five days, the temperature returned to normal. The hemoglobin decreased from 78 per cent to 54 per cent, however, and sulfadiazine was discontinued. Because of persisting diarrhea (with stool cultures negative for the typhoid-dysentery group of bacilli, staphylococci, and hemolytic organisms) 2 Gm. of sulfaguanidine were given daily for eight days; the number of stools decreased to about three a day. Since the patient insisted that she could not eat the strict rice diet any longer, toast, butter, potatoes, eggs, chicken, and liver were added in amounts of 100-800 calories
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 137 |
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-17-006-0149 |
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_0149.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 | 3 |
Page Number | 137 |
Health Discipline | Medicine |
Full Text | March, 1945 RICE DIET—KEMPNER 137 albumin 3.5 Gm., globulin 4.2 Gm., albumin-globulin ratio 0.83. Chlorides (as sodium chloride) were 574 mg. per 100 cc. of plasma; calcium was 8.7 mg. per 100 cc. of serum, phosphorus 4.2 mg., cholesterol 270 mg. The urine had a specific gravity of 1.002-1.018, and contained 1-5 red blood cells and 3-35 white blood cells per high power field, and many granular casts. The benzidine reaction was 0-1 plus. The first ten albumin determinations showed an average excretion of 1.7 Gm. per 1000 cc. The results of a phenolsulfonphthalein test were as follows: 5 per cent excretion at first half hour, 2.5 per cent at one hour, 2.5 per cent at one and a half hours, less than 2.5 per cent at two hours; total excretion in two hours less than 12.5 per cent. The test was repeated a week later and showed 10 per cent excretion at the first twenty-three minutes, 5 per cent at forty-three minutes, 5 per cent at one and a half hours, less than 2.5 per cent at two hours; total excretion in two hours 20-22.5 per cent. Impression: Chronic pyelonephritis with hypertension, vascular retinopathy, heart enlargement. Course: After five clays of strict bed rest on a diet containing 65 Gm. of protein, the blood pressure (average from the fifth to the ninth day) was 234 systolic, 144 diastolic (fig. 42). The lowest blood pressure readings during sodium amytal sleep were 190 systolic, 130 diastolic and 184 systolic, 138 diastolic. The patient complained of very intense headache every day. On the ninth hospital clay the rice diet was begun (2000 calories, fluids limited to 1500 cc., after two weeks to 1000 cc.). The blood pressure level remained almost unchanged for about three weeks. In the fourth week, first the systolic, then the diastolic pressure began to decrease gradually. After five weeks of rice diet the blood pressure average of five days was 150 systolic, 119 diastolic. The plasma chlorides (as sodium chloride) at this time were 507 mg. per 100 cc. The nonprotein nitrogen was 42 mg. per 100 cc. of blood. The albumin in the urine had decreased to an average of 0.8 Gm. per 1000 cc. The urine sediment contained a great number of white blood cells, but no red blood cells or casts. There were still numerous hemorrhages in both eyes (fig. 43). The patient was discharged on the rice diet on May 21, 1943, feeling very much better. The headaches from which she had been suffering for seven months had become much milder after two weeks of the diet and had completely disappeared after four weeks. The patient continued to follow the rice diet, to which some non-leguminous vegetables were added early in July, and was occasionally seen in the hospital. She had no headaches and no substernal oppression. Her eyesight improved markedly. The retinal hemorrhages were absorbed. The blood pressure decreased almost to normal: the average level from June 22 to July 3, 1943, was 128 systolic, 92 diastolic; from August 21 to 25, 1943, 118 systolic, 90 diastolic. The heart became smaller in size, with a change in the transverse diameter of 21 per cent (fig. 40). The total phenolsulfonphthalein excretion in two hours was 25 per cent. On October 7, 1943, the patient was readmitted because of diarrhea, anorexia, and weakness. Her blood pressure at that time was 114 systolic, 82 diastolic. The transverse diameter of the heart was 10.05 cm. (as against 11.9 cm. six months before). The electrocardiogram showed the angle of the electrical axis to be +57 degrees (as against +22 degrees six months before). The hemoglobin was 78 per cent, the nonprotein nitrogen 35 mg. per 100 cc. of blood; the chlorides (as sodium chloride) were 466 mg. per 100 cc. of serum, the total proteins 5.9 Gm. per 100 cc. of plasma (albumin 2.3 Gm., globulin 3.6 Gm.). The total nitrogen excretion in the urine was 0.94 Gm. in twenty-four hours. Sodium chloride (0.6 Gm. to 3 Gm. daily) was added to the diet during the first fourteen days. On the eighth hospital day, the temperature rose to 38.6 C. A catheterized specimen of urine was loaded with white blood cells. One and a half grams of sulfadiazine and 1.8 Gm. of sodium bicarbonate were given daily for seven days. After five days, the temperature returned to normal. The hemoglobin decreased from 78 per cent to 54 per cent, however, and sulfadiazine was discontinued. Because of persisting diarrhea (with stool cultures negative for the typhoid-dysentery group of bacilli, staphylococci, and hemolytic organisms) 2 Gm. of sulfaguanidine were given daily for eight days; the number of stools decreased to about three a day. Since the patient insisted that she could not eat the strict rice diet any longer, toast, butter, potatoes, eggs, chicken, and liver were added in amounts of 100-800 calories |
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 Treatment Of Kidney Disease And Hypertensive Vascular Disease Ivith Rice Diet, Iii |
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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