BLOOD CHEMISTRY 191 



the blood. In the elasmobranch fishes, urea serves this func- 

 tion of maintaining the osmotic pressure at the level of the 

 sea-water. An injury to the tubules which would prevent 

 reabsorption of sodium chloride might also be expected to 

 allow the diffusion back into the blood stream of the non-pro- 

 tein-nitrogen from the glomerular filtrate. The osmotic 

 pressure of the blood would be a factor in determining the 

 extent of this reabsorption and thus incidentally serve to main- 

 tain the osmotic pressure of the blood at its normal level. 



THE ROLE OF THE ELECTROLYTE DISTURBANCE IN THE CAUSATION 

 OF THE SYMPTOMS OF ADRENAL INSUFFICIENCY 



The question arises as to what part the disturbance in the 

 electrolyte balance plays in causing the symptoms and ultimate 

 death in adrenal insufficiency. Other pathological conditions 

 are also attended by a loss of inorganic base from the body; 

 e.g., diabetic acidosis, severe diarrhea, high intestinal obstruc- 

 tion, cholera, etc. These conditions are accompanied by pro- 

 found weakness, prostration, anorexia, nausea, vomiting, a 

 fall in blood pressure, retention of non-protein nitrogen, acido- 

 sis, and anuria — conditions which resemble those of the 

 "shock" observed in the terminal stages of cortical insufficiency. 

 In some instances, particularly as observed in man, the acute 

 onset of the symptoms of adrenal insufficiency are attributable 

 to the disturbed electrolyte balance of the organism, for the 

 administration of sodium chloride will bring about in these 

 cases a striking relief and recovery from imminent death. 399 

 However, adrenal insufficiency can not be considered as the 

 result solely of a disordered metabolism of the body electro- 

 lytes. Animals can not be kept alive indefinitely by the ad- 

 ministration of salts in amounts which maintain an approxi- 

 mately normal blood composition. Such animals die of the 

 typical symptoms of insufficiency even when the sodium, 

 chloride, and other blood constituents are sufficiently close to 

 normal to preclude the possibility that death is due to a de- 



