In the urinary findings of thirty-one cases of pellagra studied at the U. S. Pellagra Hospital, Spartanburg, S. C., in the spring and summer of 1917, fourteen patients showed high ammonia and low urea ratios. Of the fourteen high ammonia ratios, the ammonia was relatively increased in eight, while in the remaining six the urinary output of ammonia was much increased over that of four normal persons serving as controls. In some cases the ammonia nitrogen ran as high as 20 per cent. of the total nitrogen. In a number of cases subsequent to 1917, a high ammonia ratio was found at the time the patient entered the hospital.1
Though it was well recognized that a high ammonia ratio, whether the ammonia is relatively or absolutely increased, is susceptible of other explanations than a depletion of the normal alkali reserve of the body, or a state of acidosis, the urinary
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