Metabolic Studies in Louse-borne Typhus. Observations on Serum Electrolyte Pattern, Serum Protein Partition, and Nitrogen Balance.

Although a great deal has been written about the clinical aspects of louse-borne typhus, there have been only a few reports on the metabolic changes which occur in this disease. Among the first biochemical studies on typhus were those reported by Murchison (1) in 1862. He discovered that large amounts of urea frequently were present in the blood of typhus patients, and that their urine contained abnormally large amounts of nitrogen. He attributed this to an "exaggerated disintegration of nitrogenous tissues." Since then other physicians have postulated excessive protein destruction in association with elevated blood and urine nitrogen (2, 3). Renewed interest in this problem was aroused by recent studies '(4) which showed that azotemia, or nitrogen retention, was a common finding in louse-borne typhus, and in general related to the severity of the case. In these studies it was reported that azotemia was present in every fatal case. Little is known about the general electrolyte pattern in typhus. Murchison (1) noted that the chlorides were greatly reduced in the urine. He believed that this was due either to an impairment of absorption of chlorides or to their absolute retention. Since then other investigators have reported low chlorides in the blood of typhus patients (5). Julliard and Henaff (6) reported the serum and urine chlorides low until 1 week after defervescence. Woodward and Bland (3) reported the serum chlorides low and the carbon dioxide combining power high. They believed that a state of alkalosis existed in several of the patients, and suggested the use of ammonium chloride in the therapy. These workers also reported that often there was a reversal in the albuminglobulin ratio.