THE INTRAVENOUS INJECTION OF FLUIDS 793 



ever, has been given up, not only because it does not control the acidosis but 

 also because it produces deleterious effects. Allen, Stillman and Fitz 

 found that high dosage of bicarbonate by mouth seemed necessary in cer- 

 tain cases, but that its intravenous use failed to save any patients in their 

 series of cases. They emphasize the danger of the abuse of sodium bicar- 

 bonate in the treatment of diabetes, and in general deprecate its use at 

 all. Joslin has also discussed the harmfulness of sodium bicarbonate and 

 does not use it in the treatment of diabetes. 



Beneficial results from infusion of solutions of sodium bicarbonate in 

 cases of acute nephritis complicating cholera, as well as in certain types 

 of nephritis from other causes have been reported by Sellards. The 

 cases of chronic nephritis which he treated required the intravenous injec- 

 tion of as much as 150 grams of bicarbonate to produce an alkaline reac- 

 tion of the urine, in contrast to a normal tolerance of 5-10 grams by 

 mouth. Howland and Marriott (c) also have found sodium bicarbonate in- 

 fusions useful in the treatment of acidosis incident to diarrheas of infancy 

 and childhood. Its use is advocated by Wright and Fleming for the 

 treatment of gas gangrene in which, in severe cases, there is a great re- 

 duction of the alkali reserve. Cannon, Fraser and Hooper used bicar- 

 bonate in the treatment of the acidosis accompanying shock, but a later 

 paper by the British Medical Research Committee asserts that the restora- 

 tion of the circulation by means of transfusion, etc., renders the use of 

 alkali unnecessary in this condition. 



Good results from alkali therapy may be expected usually only in the 

 treatment of cases of acute acidosis, the development of which has been so 

 rapid that the chemistry of the body has not had time to compensate for 

 the changed conditions. Examples of this type are seen in methyl alcohol 

 poisoning and acute uremia. In such conditions, in addition to alkali 

 therapy, forced elimination is also essential. 



The practice of administering bicarbonate as routine before and after 

 surgical procedures has no justification except in the case of a considerable 

 deficit of alkali. Caldwell and Cleveland determined the change in the 

 plasma carbon dioxid before, during and after surgical operations, and 

 concluded that the diminution in the alkaline reserve below the average 

 normal does not reach the point at which the earliest clinical symptoms 

 are observed to occur, namely, about 35 volumes per cent of carbon dioxid. 

 There is at present no indication for the use of bicarbonate by mouth, 

 or intravenously, unless an alkaline deficit is present sufficiently great to 

 produce symptoms. Solutions of bicarbonate have no more effect in main- 

 taining blood pressure than normal saline, according to Bayliss. 



If treatment with sodium bicarbonate is instituted, attention should be 

 paid to the reaction of the urine. When this reaction becomes alkaline, 

 the administration of the alkali should be stopped. While the observ- 

 ance of this rule is a safe one for the majority of cases, Palmer and Van 



