734 HENRY G. BARBOUR 



scarcely to an abnormal extent. The highest acidity figures in the two 

 investigations were, respectively, P h = 5.3 and 4.85. 



Marriott and Howland(6) have found an interesting difference in the 

 reaction of dogs to hydrochloric acid on the one hand and acid phosphate 

 on the other. While the former increased the urinary ammonia parallel 

 to the acidity > corresponding amounts of the latter gave, in spite of a 

 great acidity increase, no change in the ammonia excretion. The authors 

 attribute this to a difference in "strength" of the respective acids, "weak" 

 acid being apparently unable to arouse the ammonia metabolism. 



Alkalies. Treatment of Acidosis. Walter established the efficiency 

 of sodium carbonate injections in combating the acidosis produced by 

 giving hydrochloric acid by mouth, even in the last stages. Using the 

 alkali as a preventive a triple fatal dose of the acid could be withstood 

 without increase in the ammonia excretion or the appearance of other 

 symptoms. 



In acid poisoning Salkowski and Munk and others have reduced the 

 ammonia excretion to normal by giving fixed alkali. 



In diabetes Stadehnan(a) founded the theory of acid poisoning as the 

 cause of coma and increased ammonia excretion, and instituted the alka- 

 line treatment. Subsequently M agnus-Levy developed the use of alkalies by 

 injection and per os, both in preventing and meeting the diabetic acidosis. 

 The bicarbonate is now generally employed, its potential alkalinity being 

 high in proportion to its actual (locally irritating) alkalinity. Even the 

 subcutaneous injection, which may result in serious sloughing, may be 

 accomplished with but slight irritation if the solution be first freed from 

 all traces of the carbonate (Ka 2 CO 3 ) by saturating with carbon dioxid 

 (' Magnus-Levy) . 



The bicarbonate treatment should be instituted with the appearance 

 of acetone substances in the urine; after the onset of coma it may be too 

 late. The initial dose by mouth may be 30 to 40 grams in divided doses, 

 freely diluted, given between meals. In coma oral administration may 

 be supplemented by drop enemata (4 per cent), or, for a more prompt 

 result, 1,000 c.c. of 4-6 per cent solution by vein. 



In the acidosis of anesthesia, Palmer and VanSiyke demonstrated 

 depletion of the alkali reserve of the blood and suggested prophylactic in- 

 jections of bicarbonate. Morriss employed this measure in gynecological 

 cases (under chloroform or ether) and summarizes his results as follows: 



C.C. OF CO 2 BOUXD BY 100 C.C. OF PLASMA 



Before After Differ- No. of 



anesthesia anesthesia ence cases 



Without bicarbonate 50.7 41.7 9.0 10 



With bicarbonate 54.7 49.0 5.7 10 



