Achlorhydria and its clinical significance in diabetes mellitus
- 24 Downloads
A study was made of the occurrence of anaemia, neuritis and digestive disturbances in diabetes mellitus and their association with achlorhydria.
The association of each of these conditions with achlorhydria was more than would be expected if chance or random association were the only influencing factors which had brought them together.
On the assumption that the anaemia in many cases of diabetes with achlorhydria is due to a high pH of the duodenal secretions which interferes with liberation of iron from the food materials; with its conversion to the ferrous form and also with its absorption, an attempt was made to treat the anaemia with hydrochloric acid only. Satistically, this resulted in an increase of the red blood cell count. That the difference — average increase of red blood cell count — noted was significant was found by the ratio of the difference to its probable error.
On the assumption that typical diabetic neuritis is due to a combination of destruction and defective absorption of Vitamine B1 due to a high pH of the gastric and duodenal secretions, an attempt was made to treat such cases of neuritis with hydrochloric acid only. The results in the three cases of severe neuritis cited suggest that this is probably the correct explanation.
A study was made of the occurrence of excess excretions of indican in the urine in diabetes mellitus and, compared with that noted in non-diabetics, the incidence was high and definitely higher amongst a group with achlorhydria than amongst the control group. The association of the excess excretions with achlorhydria was more than would be expected if random or chance association were the only influencing factors which had brought them together.
The probable relationships between achlorhydria and other disturbance met with in diabetes mellitus are briefly discussed.
KeywordsVitamine Hydrochloric Acid Neuritis Digestive Disease Volume Free Hydrochloric Acid
Unable to display preview. Download preview PDF.
- 2.Joslin, E. P., et al, The Treatment of Diabetes Mellitus, 8th Ed., (Lea & Febiger) 1946.Google Scholar
- 3.Jordan, W. R., Neuritic manifestations in diabetes mellitus, Arch. Int. Med., 57: 307, 1936.Google Scholar
- 4.Mead, R, cited by Warren, Shields, The Pathology of Diabetes Mellitus (Lea & Febiger) 1930.Google Scholar
- 6.Best C. H., & Shannon, H. J., The action of choline and other substances in the prevention and cure of fatty livers, Bioch. J., 29: 2651, 1935.Google Scholar
- 7.Hanssen, P., Enlargement of the liver in diabetes mellitus, J.A.M.A., 106: 914, 1936.Google Scholar
- 8.White, Priscilla, quoted by Joslin, E. P, New Eng J. Med., 209: 519, 1933.Google Scholar
- 9.White, Priscilla, Diabetes in Childhood (Lea & Febiger) 1932.Google Scholar
- 12.Rabinowitch, I. M., The van den Bergh reaction in diabetes mellitus, Brit. J. Exp. Path., 7: 155, 1926.Google Scholar
- 13.Rabinowitch, I. M., A note on the bilirubin content of blood and urbilinogen content of urine in diabetes mellitus, Brit. J. Exp. Path., 12, 249, 1936.Google Scholar
- 14.Gray, S. J., Hook, W., & Batty, J. L., Liver function studies in diabetes mellitus, Ann. Int. Med., 24: 72, 1946.Google Scholar
- 15.Monro, T. K., Manual of Medicine, 2nd Ed. (Bailliere, Tindall & Cox) 1906, p. 241.Google Scholar
- 17.Rabinowitch, I. M., Fowler, A. F., & Watson, B. A., Gastric acidity in diabetes mellitus, Arch. Int. Med, 47: 384, 1936.Google Scholar
- 18.Best, C. H., & Taylor, N. B., The Physiological Basis of Medical Practice, 3rd Ed., (Williams & Wilkins) 1943.Google Scholar
- 19.Rabinowitch, I. M., Inadequate nutrition with adequate diets; Can. Hosp. J., 25: 44, Nov. 1948; 25: 46, Dec., 1948.Google Scholar
- 20.Allison, J. T., The relation of hydrochloric acid and vitamine B complex deficiency in certain skin diseases, South. Med. J., 38: 235, 1945.Google Scholar
- 21.Hurst, A. F., Achlorhydria, Lancet, 1: 111, 1923.Google Scholar
- 22.Eggleston, E. L., Gastric secretory disturbances, Bull. Battle Creek San. & Hosp. Clinic, 20: 89, 1925.Google Scholar
- 23.Bennett, T. I. & Ryle, J. A., Studies in gastric secretion, Guy’s Hosp. Rep., 71: 286, 1921.Google Scholar
- 25.Goddman, L. & Gilman, A., The Pharmacological Basis of Therapeutics (Macmillan) 1941.Google Scholar
- 27.Needles, W., Vitamin studies in cases of diabetic neuritis, Arch. Neurol. & Psych.. 41: 1222, 1939.Google Scholar
- 28.Queries and Minor Notes, Vitamin B complex in diabetes mellitus, J. A. M. A., 129: 839, 1945.Google Scholar
- 29.Root, H. F., & Mascarenhas, C. C., Diet in uncontrolled diabetes preceding acute neuropathy, Am J. Dig. Dis., 13: 173, 1946.Google Scholar
- 30.Treusch, J. V., Diabetic neuritis, Proc. Mayo Clinic, 20: 393, 1945.Google Scholar
- 31.Bowen, B. D., & Aaron, A. H., Gastric secretion in diabetes mellitus, Arch. Int. Med., 37: 674, 1926.Google Scholar
- 32.Shay, H., Gershon-Cohen, J., & Fels, S S., Glucose tolerance in anacidity. Am. J. Dig. Dis, 5: 4, 1938–39Google Scholar
- 33.Gradwohl R. B. H., Clinical and Laboratory Methods and Diagnosis, 3rd Ed, vol. 1, p. 381 (Mosby) 1943.Google Scholar
- 34.Hawk, P. B., & Bergeim, O., Practical Physiological Chemistry, 11th Ed., (Blakiston) 1944.Google Scholar
- 35.Todd, J. C., & Sanford, A. H., Clinical Diagnosis and Laboratory Methods, 9th Ed., (Saunders) 1940.Google Scholar
- 36.Soper, H. W., The Clinical significance of indican, Am. J. Dig. Dis., 3: 564, 1937.Google Scholar
- 37.Hawk, P. B., Practical Physiological Chemistry, 8th Ed., (Blakiston) p. 568, 1923.Google Scholar
- 38.Askenstedt, F. C., A simple and improved quantitative tests for indican, N.Y. Med. J., 95: 1363, 1912Google Scholar
- 39.Root, H. F., White, P, & Marble, A, Abnormalities of calcium deposition in diabetes mellitus Arch. Int. Med., 53: 46, 1934.Google Scholar
- 40.Barney, J. D., & Sulkowitch, H. W., Progress in the management of urinary calculi, J. Urology, 37: 746, 1937.Google Scholar