THE INTRAVENOUS INJECTION OF FLUIDS 795 



treatment of a great variety of such conditions. There is, however, no 

 analytical evidence to show that such therapy succeeds in removing from 

 the body substances responsible for the symptoms. Even if dilution of 

 the toxic substances does occur, which is doubtful, it does not follow that 

 their removal from the body is a necessary sequel. All of the symptoms 

 of toxemia are subject to spontaneous changes which make difficult an 

 attempt to judge the value of any single therapeutic measure. There is 

 no reason to believe that intravenous infusions in toxemic conditions have 

 greater value than an abundance of fluid absorbed from the gastro- 

 intestinal tract. The results obtained in the past by intravenous therapy 

 are probably due to the greater facility with which the functions of the 

 body are carried on in the presence of an adequate supply of body fluid. 



4. Intravenous Infusions to assist in providing for the Calorific Re- 

 quirements of the Body. The use of glucose solutions for intravenous 

 therapy has been fostered because of the availability of glucose in processes 

 of metabolism. Unlike sodium chlorid, glucose when introduced into the 

 tissues may be completely burned, and has, therefore, none of the toxic ef- 

 fects associated with sodium chlorid which cannot be destroyed in the 

 tissues. The fuel value of glucose makes its use for purposes of infusion 

 desirable, particularly in conditions in which nutrition for various reasons 

 is not being maintained. Enriquez, by the use of a 30 per cent solution, 

 has introduced intravenously an amount of glucose equivalent to 3,200 

 calories within twenty-four hours. Glucose requires simple dehydration 

 to transform it to glycogen, and it is a physiologically efficient food sub- 

 stance. 



When an isotonic solution of glucose, 5.52 per cent, is injected intra- 

 venously, the sugar leaves the blood stream within a very brief period. 

 If a hypertonic solution is injected there is a temporary increase in the 

 blood volume caused by the withdrawal of fluid from the tissues that 

 persists until balanced osmotic relations are again established between 

 the blood and tissues. Usually this adjustment happens within thirty 

 minutes after the injection, but it may require as long as two hours, as 

 shown by von Brasol, Biedl and Kraus, Starling(a) and others. 

 The excess sugar is usually readily stored in the tissues as Kleiner found. 

 The amount of sugar excreted by the kidneys is variable. Kleiner 

 found in dogs that 60 per cent of the injected sugar was excreted in the 

 urine, but the degree of glycosuria and its duration depend not only upon 

 the state of the kidneys and the rate of blood flow, but upon the amount 

 of sugar and the rate at which it is injected as well. ' After intravenous 

 injection in man, at a tolerant rate of 300 c.c. of a 30 per cent solution, 

 Enriquez found at most 4-5 grams of glucose in the urine during the first 

 two hours after the injection and none thereafter. Woodyatt, Sansum 

 and Wilder, by means of timed injections, have determined the tol- 

 erance in man for sugar as 0.85 gram per kilogram per hour. For a 



