THE INTRAVENOUS INJECTION OF FLUIDS 709 



may be used for the same indications as grim acacia. Hogan demon- 

 strated by blood pressure readings and rate of urinary secretion that this 

 solution remained in the circulation for a considerable period of time. 

 It does not, however, possess the same viscosity as blood. Furthermore, 

 unless special care is taken, heat destroys the colloidal properties of 

 gelatin, upon which its usefulness in this connection depends. Steriliza- 

 tion of the solution also is difficult, owing to the frequent presence of 

 spores of tetanus bacilli. In spite of these disadvantages, gelatin solutions 

 may be of great use if they are made with the precautions suggested 

 by Hogan. 



4. Sodium Bicarbonate Solutions. Sodium bicarbonate solutions in 

 strengths varying from 2 per cent to 6 per cent are customarily made up 

 in normal saline. When such a solution is boiled in the process of steril- 

 ization, much of the bicarbonate is converted into carbonate. The car- 

 bonate is caustic, and is capable of producing extensive sloughing of sub- 

 cutaneous tissues. It may, however, be injected safely into the blood 

 stream. Carbonates, as such, should not be used as a. rule, even for in- 

 travenous injection, because of the possibility of infiltration about the 

 vein with consequent tissue destruction. After boiling a solution of 

 sodium bicarbonate, carbon dioxid should be bubbled through the solution 

 to reconvert the carbonate to bicarbonate. Contrary to statements in 

 the literature (Stadlemann(a)), not only is the alkalinity of a bicarbonate 

 solution altered by boiling, but also the caustic properties of carbonate in 

 such solutions cannot be neglected. Joslin is authority for the statement 

 that sterilization of bicarbonate is probably not necessary. If not ster- 

 ilized, it should be handled with sterile utensils and dissolved in sterile 

 normal saline. Solutions of bicarbonate or carbonate should not be in- 

 jected subcutaneously. 



f Some of the effects following the injection of sodium bicarbonate are 

 easily measured. The carbon dioxid tension of the alveolar air is in- 

 creased, the carbon dioxid content of the blood rises, and urine becomes 

 alkaline usually when the tolerance is reached, and in some cases of 

 nephritis, as Sellards has shown, diuresis may be pronounced. Allen, 

 Stillman and Fitz suggest that great care is necessary when sodium 

 bicarbonate is given intravenously, not to force a blood having low alka- 

 linity suddenly to one having a normal or above normal alkalinity. A 

 favorable progress is indicated if the level of bicarbonate tends gradually 

 upward. 



5. Glucose Solutions. Glucose is a monosaccharid which shares with 

 fructose the characteristic of being more readily assimilated than any 

 other sugar. It is highly soluble in water, is non-toxic, and may safely 

 be given in concentrations up to 30 per cent to 35 per cent. The isotonic 

 solution is one of 5.52 per cent . When injected into the circulation in 

 isotonic or hypertonic solutions, the excess of sugar is rapidly eliminated 



