Acidosis in Cholera. I. Path of Displacement of Serum Acid Base Equilibrium

Abstract

During the outbreak of cholera in the summer of 1932 we had the opportunity of studying 28 cases from the standpoint of their serum acid-base equilibrium. With the micro-acid-base method of Shock and Hastings, 1 cell volume, pH, and total CO₂ of blood were determined and from these values serum bicarbonate content in millimols per liter and carbon dioxide tension in millimeters of mercury were calculated. These observations were made on admission before treatment and repeated thereafter almost daily throughout their hospital sojourn. Altogether 222 observations were made.

During the acute stage of cholera there was invariably acidosis. Serum pH obtained from this series of cases on admission averaged 7.28, bicarbonate content 14.1, and CO₂ tension 30.7. The lowest pH recorded in this series was 7.07, the lowest bicarbonate content 8.2, and the lowest carbon dioxide tension 16.6, as compared with the normal average values of 7.40, 26.6, and 44.9, respectively.

With recovery following intravenous therapy with either saline or alkali or both, pH returned to normal fairly rapidly and was followed by the return of bicarbonate. Soon after these values returned to normal they were often shifted to the alkaline side. Fourteen cases in this series which were followed for a relatively long period during their convalescence showed a tendency to alkalosis, irrespective of whether or not they had received alkali. During the stage of alkalosis these cases showed on the average pH 7.51, bicarbonate content 31.3 and CO₂ tension 42.3.

In the 4 cases of death in this series the intravenous treatment was capable of bringing the serum pH and bicarbonate content to normal, but this was only temporary.