88 DONALD D. VAN SLYKE 



ministered, but also the rate at which it is permitted to enter the circula- 

 tion. If the condition is, for example, the most familiar one of compensated 

 alkali deficit (Area 6, Fig. II), the more important of the two factors, the 

 pH, is still normal. It is desirable to restore also a normal bicarbonate 

 of the body fluids in order to place a safe reserve of alkali between the ex- 

 isting condition and the distinctly dangerous one of uncompensated alkali 

 deficit (Area 9, Fig. II). But the restoration of the alkali reserve should 

 be accomplished so gradually that at no time is the pH harmfully shifted 

 to over-alkalinity. If bicarbonate is administered slowly, the organism 

 can, by retarding somewhat its respiration, retain sufficient carbonic acid 

 so that BHCO 3 and H 2 CO 3 make parallel increases, and the BHCO 3 : 

 H 2 CO 3 ratio and the pH remain normal. 



If bicarbonate is given as prescribed by Stillman(a) (1919) for diabetic 

 acidosis, at the rate of 3 grams per hour, dissolved in cold water and given 

 by mouth, until the blood bicarbonate becomes normal, there appears to be 

 little danger of causing an abnormally high pll. If, on the other hand, bi- 

 carbonate is injected intravenously in massive doses, a rise in the blood 

 pH seems inevitable. Instances of tetany in both adults (Harrop(a), 

 1919) and in children (Howland and Marriott (6), 1918) as the result of 

 intravenous injection of bicarbonate are on record. It occurs also after 

 overdosage, even of alkali given slowly by mouth, but the danger seems 

 distinctly less in this form of administration. 



It appears that as a rule the most desirable way to administer bicar- 

 bonate is by mouth in doses of not over 0.1 gram per kilo body weight 

 each hour. In uncompensated acidosis, with lowered pH and air hunger, 

 this rate can perhaps be doubled. When, as in diarrhea of infants, the 

 effect of bicarbonate on the alimentary canal would be unfavorable, intra- 

 venous injections must be used, but massive single doses are to be avoided 

 in favor of smaller repeated doses. And finally, when by correcting the 

 diet, as by use of a green vegetable diet or protein diet low in fats in 

 diabetes (Stillman, 1919), or by glucose or lactose administration in non- 

 diabetic ketoses (Duncan and Harding, 1918) the organism can be put 

 into a position to restore its own acid-base balance, it appears desirable to 

 assist it to do so without alkali administration. 



Acidosis in Certain Conditions 



Diabetes. Type and Cause of Acidosis. The acidosis which occurs in 

 severe diabetes is caused, as shown in the notable work of Magnus-Levy (e) 

 (1899), by rapid formation of the so-called acetone-bodies, acetoacetic 

 and (Miydroxybutyric acids, the products of incompletely burned fatty 

 acids. Magnus-Levy found no evidence of significant formation of other 



