The Blood Urea Nitrogen in Acute Intestinal Obstruction

The subject of acute intestinal obstruction has attracted interest for a considerable time both from a clinical and experimental standpoint.Ever since it was found that acute intestinal obstruction was amenable to operative therapeusis, surgeons have urged the early diagnosis of this condition, because they had learned that the success of their opera- tive procedures was largely dependent on relieving the obstruction before the toxemia, which so conspicuously accompanies this condition, overwhelms the patient.The early recognition of acute intestinal obstruction, however, not infrequently presents difficulties even to skilled and experienced observers, chiefly due to the absence of the classical symptoms of the disease which often do not make their appear- ance until the intoxication has advanced to an alarming degree.In recent years the development of blood chemistry methods and their application, first, in clinical cases, and, later, in experimental cases of intestinal obstruction, have shown a striking elevation in the blood urea nitrogen and noncoagulable nitrogen, and have suggested the possible value of these determinations in diagnosis.The purpose of this com- munication is to describe a brief series of cases of acute intestinal obstruction and to report the observations which were made on the blood urea nitrogen.In 1914, Tileston and Comfort,1 in the course of a study of the blood chemistry in a large series of miscellaneous cases in human beings, found that in three cases of acute intestinal obstruction there was a surprisingly high elevation of the blood urea nitrogen and noncoag- ulable nitrogen.In these cases the blood urea nitrogen varied from 59 to 77 per cent, of the total noncoagulable nitrogen.Their highest blood urea nitrogen in a case of obstruction terminating in recovery was 92 mg. per 100 c.c. and their lowest reading was 45.5 mg.In a case of acute obstruction due to an intestinal band which terminated fatally in spite of operation, the blood urea nitrogen rose from 72.8 mg. at the time of operation to 114 mg.immediately prior to death.The phenol- sulphonephthalein excretion was determined in two cases.In the first case it varied from 25 to 43 per cent., whereas in the second case it was 70 per cent. in 2 hours and 10 minutes.