BLOOD CHEMISTRY 189 



sodium in adrenal insufficiency by injecting isotonic glucose 

 into the peritoneal cavity and later withdrawing the fluid after 

 ionic equilibration has occurred. In this way one obtains a 

 marked fall in the concentration of the serum sodium and a 

 slight drop in the osmotic pressure of the serum. A shift of 

 water into the blood cells depletes the extracellular fluid. 

 This procedure, as utilized by Gilman, 221 does not reproduce 

 exactly the conditions obtaining in adrenal insufficiency for it 

 does not involve a loss of fluid from the circulation. The 

 rapidity with which the depletion of sodium occurs is not com- 

 parable to the more slowly progressive changes occurring in 

 adrenalectomized animals. In the latter, the accumulation of 

 non-protein nitrogen constituents in the blood will counteract 

 the development of any drop in osmotic pressure such as 

 follows the intraperitoneal injection of glucose. Gilman 

 demonstrated an analogy between the sensitivity of his animals 

 to hemorrhage with that observed in adrenal insufficiency. 

 His conclusion that a shift of water into the cells occurs in 

 adrenal insufficiency as it does in his procedure does not, how- 

 ever, follow. In adrenal insufficiency the loss of fluid through 

 the kidneys with a consequently diminished blood volume 

 accounts for the sensitivity to hemorrhage, without necessitat- 

 ing the assumption of a passage of water into the cells and 

 tissues such as occurs after the intraperitoneal injection of 

 glucose. 



Harrop, 266 Loeb, 398 and their coworkers have reported studies 

 on the water, sodium and chloride balances in animals during 

 cortical insufficiency as well as during periods of recovery fol- 

 lowing the injection of the cortical hormone. They have 

 demonstrated that the loss of sodium and chloride through the 

 urine in excess of the amounts ingested is greater than can be 

 accounted for by the loss of these constituents from the plasma. 

 Part of the excreted sodium and chloride must be derived, 

 therefore, from the tissues. 



The injection of cortical extract into animals in adrenal in- 



