92 DONALD D. VAN SLYKE 



or urine s also noted. If a low blood bicarbonate is due to genuine alkali 

 deficit, the urinary pH will be, according to Schloss, below 5.3; if the 

 fall in blood bicarbonate is merely a secondary result of hyperpnea, the 

 urinary pH will be much higher. Because hyperpnea and in consequence 

 low alveolar CO 2 may occur when the acid-base balance of the blood is 

 normal, it appears that alveolar CO 2 figures are unreliable for the diagnosis. 



Therapy. Schloss and Harrington (1919) in cases with lowered 

 plasma bicarbonate and acid urine give sodium bicarbonate intravenously 

 until the urinary pH exceeds 5.3. Bicarbonate by mouth is contraindicated 

 because of its effect on the alimentary tract. 



Cyclic Vomiting of Children. Type and Cause of Acidosis. This 

 condition of unknown cause is, at times at least, accompanied by an ex- 

 ceedingly rapid formation of acetone bodies, and acid-intoxication as an 

 important factor in the. symptoms was recognized by Edsall(a) (1903). 

 Studies on the acid-base balance of the blood appear as yet lacking. That 

 the acidosis may temporarily approach in severity that of diabetic coma 

 seems probable, however. The intense air-hunger, rapid pulse, and semi- 

 comatose but excited condition typical of the precoma stage of diabetes 

 are also noted here (Hecker, 1914; Hodges, 1914). In one case which 

 chanced to come under the writer's observation the 24-hour excretion of 

 ammonia plus titratable acid exceeded 100 c.c. of 0.1 N solution per kilo, 

 which in diabetes indicates acidosis bordering on coma (Table II). The 

 alkali retention was correspondingly high. 



Diagnosis. The cause of the disturbance in acid-base balance is, as 

 in diabetes, the acetone bodies. Acidosis may therefore be detected or 

 excluded by the same methods described above for diabetes. 



Therapy. Edsall (1903) introduced the use of bicarbonate. When 

 it can be retained, bicarbonate given by mouth during an attack appears 

 greatly to alleviate the air-hunger and other symptoms. Given when the 

 onset is indicated by the prodromal symptoms and appearance of acetone 

 bodies in the urine it may abort the attack. The general treatment is 

 detailed by Hecker (1911) and by Marfan (1916). 



Acidosis after Anesthesia. The condition of the acid-base balance 

 during and after anesthesia is at present so little understood that one 

 does not appear justified in drawing conclusions in a given case unless both 

 blood bicarbonate and pH are known. That a fall in bicarbonate occurs 

 during etherization is certain (Caldwell and Cleveland, 1917). Hender- 

 son and Haggard(6) (1917), however, explain it as due to H 2 CO 3 deficit 

 from hyperpnea (Area 3, Fig. 2), and Henderson, Haggard, and Coburn 

 (1920) recommend administration of air containing CO 2 as the remedy. 

 Their explanation is diametrically opposed to the results of Menten and 

 Crile (1915) and of Van Slyke, Austin, and Cullen (1920) who found 

 lowered pH in etherized animals. Lowered pH combined with lowered 

 bicarbonate indicates uncompensated acidosis. The observations of Collip 



