Treatment of Dehydration of Diarrhea with Parenteral Fluids. II. Effect on Excretion of Fixed Acid and Base.

Abstract

Hartmann 1 believes that diarrhea increases the relative loss of fixed base∗ from the body, first because there is a less complete resorption of alkaline intestinal secretions, and second, because with the accompanying oliguria there is a decreased excretion of fixed acids.∗ He states that the parenteral injection of NaCl solution may augment the accumulation of fixed acids in the blood by the retention of chlorine-ions leading to a reduction of the plasma bicarbonate content. He cites that portion of the data published by Holt, Courtney and Fales 2 which shows that loose stools contained much larger quantities of fixed base, especially sodium and potassium, than did normal stools. He failed, however, to point out the fact that the excretion of the fixed acids increased in a proportionate manner. Furthermore, the data are unsuited to an adequate consideration of the total loss of acid and base from the body because of the lack of published analyses of the urines.

In an attempt to add to the available data we determined the quantities of fixed acids and base in both the urine and stools of 6 infants with diarrhea in 8 periods of active treatment with parenteral fluids. These fluids consisted of hypodermoclyses of isotonic NaCl solution followed usually by the intravenous injection of 10% glucose solution. Collections of the excreta were begun at varying intervals following the first treatment and were continued for as long as 48 hours whenever circumstances permitted.

As a basis of comparison, a similar study was conducted on 3 normal untreated infants in 4 collection periods. A normal preponderance of fixed base over fixed acid was apparent in the total excreta of all 3 infants. This relation is most simply expressed as an acid :base ratio.