The most obvious example of a lowering of basal metabolism occurring in an edematous state is witnessed in the so-called nephroses, or better termed "hypoproteinemias." Because of this association, Epstein1 regarded "nephrosis" as a metabolic disease. Indeed, the remarkable tolerance of patients with such a condition for thyroid preparations seemed to justify this contention. However, with the evolution of the broader concept of the "nephrosis" it soon became apparent that the disease could not be a primary metabolic disorder, because a lowered basal metabolism accompanies most conditions, both renal and extrarenal, in which hypoproteinemia is a prominent finding. In other words, the lowered basal metabolism is a secondary and not a primary phenomenon, and the immediate issue with which this study is concerned is the determination of the factor or factors which cause its depression. This in turn leads to a larger problem, namely, the relation of lowered metabolism
MOSCHCOWITZ E. EFFECT OF EDEMA AND INTEGUMENTARY INFILTRATIONS ON BASAL METABOLISM, ELECTROCARDIOGRAM AND BLOOD CHOLESTEROL. Arch Intern Med (Chic). 1941;67(4):828–845. doi:10.1001/archinte.1941.00200040121009
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