The etiologic significance of lowered blood-sugar values in vomiting of pregnancy

Abstract

1.1. The carbohydrate deficiency theory as the chief underlying factor in the causation of pregnancy toxemias has been physiologically reasonable; the success of the therapeutic measures founded on this theory has been convincing, but laboratory proof of its correctness has been lacking.2.2. Recent work on the fluctuations in blood sugar during eclampsia has demonstrated that a disturbance in carbohydrate metabolism is a factor in this toxicosis of pregnancy, and that eclamptic convulsions are hypoglycemic reactions occurring at the low point of these fluctuations.3.3. Blood-sugar readings taken under certain standard circumstances from patients with hyperemesis gravidarum indicate that in this condition low values predominate as a characteristic of this diseased state.4.4. Even among those patients showing normal values (80 to 100 mg.) the tendency is toward the lower rather than the upper limits of the average range.5.5. Such tendencies indicate a glycogen depletion in hyperemesis, previously postulated from clinical observation.6.6. The lowest values indicative of the most profound glycogen depletion of the tissues are to be seen in the sickest patients.7.7. Hypoglycemic levels may be attained in hyperemesis which if compared to similar values obtained more rapidly from insulin overdosage would be expected to cause convulsions, but which fail to do so because this process of glycogen depletion is a slow one. Fulminating cases of hyperemesis, or “acute yellow atrophy of the liver” frequently show convulsions early in pregnancy which are comparable to those of eclampsia, late in pregnancy.8.8. The probability of an etiologic relationship between toxicoses of early and of late pregnancy is strengthened by these observations and findings.9.9. The reason for the successful results from the hitherto empiric treatment of hyperemesis by intravenous injections of glucose and other administration of carbohydrates is now apparent.10.10. The use of insulin without glucose in hyperemesis is shown by these low sugar values to be a dangerous procedure. Its use with glucose has already been questioned.11.11. Careful laboratory control of the blood chemistry of these patients with particular respect to their blood-sugar values, is essential to their treatment.