EFFECTS OF CERTAIN DRUGS AND POISONS 735 



In studies of anesthesia Killian found the acidosis, increased diastatic 

 activity and sugar content of the Llood all controllable by alkali (e. g., 20- 

 30 grams of bicarbonate per os). The blood acetone bodies in operative 

 anesthesia Reiinann and Bloom found increased sufficiently to account 

 for from 20 to 100 per cent of the bicarbonate depletion. They endorse 

 the recommendation that in cases where the carbon dioxid capacity is 

 less than 58 c.c. the bicarbonate be used prophylactically. 



The alkali depletion resulting from the overventilation usually accom- 

 panying light ether anesthesia can, as Henderson and Haggard have shown, 

 be prevented by administration of a suitable carbon dioxid mixture with 

 the anesthetic. Reiinann and Ilartman prefer the bicarbonate to the gas, 

 believing it advisable to introduce more alkali into the body to combat the 

 production of acid metabolites. 



Uranium nephritis is associated, as MacNider(a) (b) has shown, with 

 ketosis and depletion of the plasma bicarbonate. He finds that alkali injec- 

 tions protect against the toxic effects of uranium as well as against the un- 

 favorable action which anesthetics exert upon the kidneys whether uranium- 

 poisoned or "naturally nephropathic." Furthermore, the action, of 

 diuretics in these conditions is enhanced by sodium carbonate. 



In the acute experimental nephritides of cantharadin, arsenic, diph- 

 theria toxin and chromate poisoning Goto(a) (b) has reduced the acidosis 

 with oral bicarbonate injections. 



In* the "retention acidosis" of nephritis Denis and Minot(fr) find that 

 small intermittent oral doses of bicarbonate keep the urine free of 

 ammonia. 



In infants a type of acidosis occurs during attacks of severe diarrhea; 

 dyspnea is present but no cyanosis, and Czerny states that mineral acid 

 poisoning in rabbits is simulated. Howland and Marriott (c) were the first 

 to attempt the rescue of such children by the alkaline treatment. The 

 blood was found free of acetone bodies in this condition. In one of their 

 cases treated with bicarbonate the alveolar carbon dioxid tension (in 

 millimeters) was on five successive days: 21, 42 ,54, 55, 41. The normal 

 tension for infants is 3G-45 millimeters. On the third day therefore the 

 treatment was stopped. 



Blood studies of such children have shown not only a depleted alkali 

 reserve, but also a reduction from P h 7.4 to P h 7.2. Anuria is fre- 

 quent and the acidosis is attributable to a retention of acid phosphate in 

 the organism. 



Schloss and Stetson have in similar cases reported, besides the de- 

 creased carbon dioxid in alveolar air and blood, a high ammonia co- 

 efficient and an increased ''bicarbonate tolerance." 1.25-3.25 grams of 

 sodium bicarbonate rendered the urine alkaline in normal infants, while 

 5.5-7.0 grams was required to accomplish this in cases of acidosis. Such 



