Acidosis in Cholera. II. Changes in Serum Electrolytes

Abstract

Of the series of cases of cholera reported in the preceding paper, 1 more detailed studies were made on 13 in order to gain a more complete picture of the changes in serum electrolytes. Besides pH and bicarbonate content, we also determined serum total base, chloride, phosphate, proteins and lactate. These determinations were made during the acute stage, usually before treatment, and repeated at intervals during the course in the hospital. Altogether 48 determinations were made on the 13 cases.

The average values obtained during acute stage on admission and those on recovery are presented in Table I. It is noted that in the acute stage besides the decrease in pH and bicarbonate content, there is a distinct reduction in serum total base and chloride concentrations and an elevation of phosphate, lactate, and, to a lesser extent, proteins. These changes tend to disappear with recovery from acute symptoms, although the rate of return to normal of individual constituents may vary considerably. When the values obtained on admission are compared with those on discharge, it may be observed that during the acute stage sufficient base is lost from the body to lower the serum base concentration to the extent of 14.1 milli-equivalents per liter. Added to this alkali deficit from loss of base is the increased demand for base from the increase of 2.2 milli-equivalents in phosphate, 2.3 milli-equivalents in protein and 4.5 milli-equivalents in lactate, totalling 9.0 milli-equivalents. The combined alkali deficit from loss of base and from increased demand for it amounts to 23.1 milli-equivalents. This alkali deficit is shared by bicarbonate and chloride.