Studies on Acholic Cachexia. III. ∗ The Acid-base Equilibrium

Abstract

For many years it has been assumed that since the bile was alkaline, loss of bile would consequently produce an acidosis. The importance of this factor in acholic cachexia has been a disputed point.

Okada 1 studied fistula bile from dogs and found a pH averaging slightly over 8.00, Düttmann's 2 investigations showed it a trifle lower. In the prolonged studies of Drury, McMaster and Rous 3 duct bile averaged pH 8.20. Neilson and Meyer 4 found figures in the same range, but called attention to the fact that on standing, or heating, duct bile would increase its alkalinity, the pH rising to 8.40-8.60. This was presumably due to driving off of CO₂. Drury 3 emphasized the point that the bile is a well-buffered solution, and that addition of considerable amounts of acid were necessary in order to change the reaction. In this connection it is well to remember that considerable fixed acid is lost with the bile, as Wangen-steen 5 found that a human with a biliary fistula secreted about 0.4 gm. NaCl daily.

In many previous studies too numerous to mention here, the presence of a mild degree of acidosis has been quite usual, while a few investigators have found it to be of such a high grade as to regard it as a primary factor in the accompanying cachexia. The material here reported consists of CO₂ and blood chloride estimations on 8 animals, part with biliary fistulas and part with cholecystnephros-tomies. From the accompanying table it may be seen that there are no significant changes in the acid-base equilibrium. The average CO₂ before operation was 39.5, exactly that taken at the conclusion of the experiments (39.5). The average preoperative blood chloride was 290 mg. per 100 cc. and at the conclusion of the experiments was 293 mg. per 100 cc.