792 AELJE V. BOCK 



the most efficient therapy in all severe eases. In shock without hemor- 

 rhage intravenous injection of a fluid substitute for blood is indicated. 



In conditions other than hemorrhage and shock, in which fluid de- 

 pletion occurs, there is not usually the urgent necessity for an immediate 

 increase of the volume of the blood. Dehydration of the tissues in gen- 

 eral, however, is always a serious matter and demands energetic measures 

 to combat the deficit of fluid. Such fluid loss is met with in conditions 

 mentioned on page 789. To increase the store of body fluids in such 

 states it may be necessary to use one or more of the following absorption 

 routes: from the gastro-intestinal tract, which is the one of choice; by 

 subcutaneous injection, or intravenous infusion. If the treatment is 

 necessary because of vomiting, for example, large amounts of normal 

 saline may be absorbed from the subpectoral areas. Injections of this 

 type may be repeated as frequently as absorption occurs. If conditions 

 prevent the use of the alimentary tract, the same object can be achieved 

 with more comfort to the patient by the intravenous injection of fluids 

 such as normal saline or glucose solutions. Intravenous injection of 

 suitable amounts of fluid may be repeated every four hours. 



2. Intravenous Infusions to Increase the Buffer Action of the Blood 

 in Acidosis.It is not intended here to discuss the question of acid 

 intoxication in the body. However, the intravenous use of solutions of 

 sodium bicarbonate in combating acidosis requires a brief discussion of the 

 basis for the use of alkali in this condition. IIenderson(&) has shown the 

 importance of the phosphates and carbonates in maintaining a constant 

 reaction of the blood. These bases exist in balanced solution in the 

 blood, and are able to take up relatively large quantities of acid or alkali 

 without greatly altering its normal alkalinity. This mechanism, together 

 with a similar action of the proteins of the blood, constitutes the buffer 

 action of the blood. For practical purposes the buffer salts may be 

 regarded as bicarbonates. They may be measured in terms of carbon 

 dioxid, with which they combine, by the method of Van Slyke(6) or Y. 

 Henderson and Morris. The constancy of the reaction of the blood is 

 maintained chiefly by the elimination of carbon dioxid in the lungs, 

 and of acid radicals by the kidneys. In each cycle of blood the bases thus 

 tend to be conserved in the body. In pathological conditions extreme de- 

 pletion of the bases may occur in an attempt to maintain the normal 

 reaction of the bloodo In these conditions the administration of alkali 

 is advocated in order to renew the lost bases from the blood and tissues, 

 as well as to neutralize non-volatile acids being formed in the body. 



Theoretically, the administration of an alkali such as sodium bicar- 

 bonate, first suggested by Stadlemann(a) in 1SS3, should be an efficient 

 means of restoring the alkali reserve of the body, and thus become an aid 

 iu the treatment of the acidosis associated with diabetes. The earlier, al- 

 most universal, use of bicarbonate for the treatment of this condition, how- 



