CHEMICAL STUDIES OF THE BLOOD IN HIGH INTESTINAL OBSTRUCTION: II. The Relation between "Toxemia" and Chemical Changes.

This paper presents an investigation of the effects of experimental high intestinal obstruction in dogs, with particular emphasis on changes observable in the distribution of phosphorus in the blood. The experiments were undertaken as a part of a series of studies of phosphorus distribution in the blood of man and experimental animals in a variety of pathologic conditions. In dogs, marked changes of the distribution of phosphorus were observed following pyloric and mid-duodenal obstruction; an attempt is here made to correlate these changes with the variations in the blood electrolytes commonly observed in intestinal obstruction. That experimental high intestinal obstruction brings about or is accompanied by marked changes in the blood has been demonstrated in many investigative studies of this problem reported during the past few years. The more important of these changes are: (1) Concentration of the blood indicated by an increased relative cell volume, cell count and serum protein content. (2) Increased nonprotein nitrogen, mostly urea. (3) Low chloride, generally conceded to be due to losses of Cl by secretion into the stomach or the obstructed gut, whence it is vomited or fails to be reabsorbed. (4) High CO2 content, increased in compensation for the loss of chloride except when there is an accumulation of acids (such as lactic), or when there is great loss of base as well as chloride in the vomitus. It was first pointed out by Gamble and Ross (1925) that the reduction of the ionic content of the body fluids by the losses of electrolytes (base as well as chloride) is the significant factor in the rapid general dehydration of the body that follows pyloric obstruction. Reviews of the many investigations of intestinal obstruction may be found in the articles by Ellis (1922), Gatch, Trusler and Ayers (1927), Cooper (1928), McVicar and Weir (1929) and in three papers of a sym-