Treatment of Dehydration of Diarrhea with Parenteral Fluids. I. Effect on Acid-base Status of Blood.

Abstract

Relief of the clinical symptoms of dehydration in infants with diarrhea is usually secured by the prompt and energetic administration of parenteral fluids. The assumption is generally made that the disturbed chemical relations in the blood are simultaneously improved. Hartmann, 1 however, has recently presented data from which he concludes that the injection of NaCl solution in severely dehydrated infants may lead to a rising chlorine concentration with a consequent fall in bicarbonate content. He assumes that continuing oliguria must be present to permit the development of this unfavorable result. The explanation offered for the acid-producing power of the neutral salt NaCl is the inability of the body to rid itself of the chlorine-ions by excretion through the kidneys as rapidly as the sodium-ions are lost through the intestine. This theory takes proper cognizance of the seriousness of oliguria 2 but at the same time leads to confusion by assuming that a restoration of urine flow is impossible—an assumption which we believe is untenable.

We studied the acid-base status of the bloods of 14 dehydrated infants who were treated with parenteral fluids sufficient in quantity to produce and maintain diuresis. The routine treatment comprised the use of hypodermoclyses of physiological solutions of NaCl (about 20 cc. per pound of body weight) followed by intravenous injections of 10% glucose solution (about 10-12 cc. per pound of body weight) to assist in diluting the plasma and to promote urine flow. This procedure was repeated as indicated by clinical and laboratory findings. Every degree of dehydration was represented but the majority of the cases were of moderate severity. Four of the 14 infants died.

Blood samples were collected before and at variable intervals during treatment. The specimens were drawn without stasis, were immediately placed under oil and the sera analyzed for total fixed base and the most important acid radicles, including chloride, bicarbonate, protein and phosphate.