Westwater, John Ovenstone

2019-02-15T14:26:33Z

2019-02-15T14:26:33Z

1937

#1. Evidence of suprarenal insufficiency has been sought in 174 patients with tuberculosis. Clinical features have been examined and the level of sodium in the blood serum investigated. #2. Serial sections of glands obtained at autopsy showed suprarenal abnormality in eleven patients. • Serum sodium above 315. • • Three autopsies. • • • One positive inoculation for tubercle bacilli. • Serum sodium below 315. • • twenty -two autopsies. • • • Seven positive on inoculation for tubercle bacilli. • Serial sections. • • Two definite tuberculous lesions. • • Pour small tuberculous foci. • • One amyloid degeneration. #3. Suprarenal insufficiency was diagnosed in four patients, two showed tuberculous lesions of the suprarenals, in one there was no evidence of disease in the glands, while the other is untraced. #4. The normal range of sodium has been assessed as 315 to 350 mgms per 100c.cm. of serum. #5. In 114 cases the level of serum sodium was normal. • In 60 cases the level of serum sodium was low. #6. A low serum sodium indicates a bad prognosis. #7. Such suprarenal lesions as were found, occurred with one exception, in Group with low serum sodium. #8. Pigmentation of the skin was present only in the group with a low serum sodium. #9. Cases with pyrexia, sweating, diarrhoea or vomiting did not have of necessity a low serum sodium. #10. There is no proof that serous effusions or purulent discharges can drain away sufficient sodium to account for the low level, nor that they upset the sodium balance. #11. There is no evidence that cases with a low serum sodium had a low enough sodium intake to explain the decreased serum level. #12. Even with a low sodium intake there is an appreciable loss of sodium in the urine. #13. In the presence of a low serum sodium continued excretion of sodium in the urine suggests suprarenal damage, even'with a low intake. #14. In the absence of factors such as severe vomiting or diarrhoea a low serum sodium is suspicious evidence of suprarenal insufficiency.

http://hdl.handle.net/1842/34401

The University of Edinburgh

Annexe Thesis Digitisation Project 2019 Block 22

Suprarenal insufficiency in tuberculous patients, with special reference to the sodium level in the blood serum

Thesis or Dissertation

Doctoral

MD Doctor of Medicine