EFFECTS OF CERTAIN DRUGS AND POISONS 730 



While the exact effects upon either the combustion or the storage of 

 glucose are not as clear as the influence of alkali upon renal permeability 

 it may safely be affirmed that acids and alkalies tend, within certain limits, 

 to increase and decrease, respectively, the excretion of sugar. 



Protein Metabolism. The augmented excretion of various protein 

 metabolites, following administration of dilute mineral acids, described 

 by some observers, is probably chiefly a diuretic effect. Alkalies have not 

 been shown to affect appreciably the protein eatabolism. Jawein fovmd 

 that 20-40 grams of sodium carbonate or citrate produced in man either 

 inconstant changes or none at all. The neutral sulphur of the urine, how- 

 ever, appeared to be increased at the expense of the acid sulphates. 



The retention both of non-protein and of urea nitrogen in the acuto 

 nephritis of metal poisoning, etc., was overcome in Goto's experiments 

 by alkali "administration. 



The excretion of creatin in rabbits may be initiated or augmented by 

 acids or diminished or abolished by alkalies, as shown by Underbill^*). 

 Denis(Z) and Minot(cf) failed to establish such a relationship in a few 

 human cases. 



Purin Metabolism, The alkalies have been extensively used in gout, 

 partly on the theory that the supposed combustion increase would destroy 

 more uric acid and partly in an attempt, by neutralizing this acid, to pro- 

 mote its excretion. We have seen, however, that increased oxidation has 

 not been established and Hitter has shown that no direct solvent action of 

 alkalies upon urato tophi can occur in the body. MacLeod and Haskins 

 maintain that citrates by their alkalinity increase the elimination of 

 endogenous uric acid and purins, but this may be due to intestinal 

 derangement. 



The "alkaline cures" for gout probably owe their beneficial effects 

 merely to the considerable quantity of fluid ingested. In spite of the 

 greater solubility of urates in alkaline form, alkalies do not remove gouty 

 calculi from kidney or bladder; furthermore, alkalinity of the urine is 

 likely to promote the deposition of phosphates. 



Tetany. Wilson and his associates found intravenous injections of 

 hydrochloric acid effective in preventing the tetany which follows thyreo- 

 parathyroidcctomy. They describe tetany as a condition of alkalosis. 

 McCann found a lowered carbon dioxid capacity of the plasma in this 

 condition and states that tetany may sometimes depend upon derange- 

 ments in the acid-base relations of the alimentary secretions. 



Harrop(a) has described a case of tetany resulting from the intravenous 

 infusion of sodium carbonate in an adult suffering from mercuric hi- 

 chlorid poisoning and totally anuric. He emphasizes the danger of 

 the use of bicarbonate in cases of marked renal impairment. Tetauy has 

 occasionally been observed in young children given sodium bicarbonate for 

 acidosis. 



