704 ARLTE V. BOCK 



vSlvko have shown that in pathological conditions there is flanker of givin^ 

 too much bicarbonate it the administration is continued until the urine 

 becomes alkaline in reaction. An alkafosis may result in such cases, a 

 condition probahly not more desirable than the previously existing slate 

 of acidosis. For example, Wilson, Stearns arid Thurlow have shown 

 the existence of alkalosis in cases of tetany following parathyroidectomy. 

 Tileston has produced tetany in a case of Weil's disease by the ovcrad- 

 ministration intravenously of sodium bicarbonate, having established 

 thereby an alkalosis of moderate degree. The onset of tetany in a case 

 of bichlorid poisoning after the administration intravenously of GO grams 

 of bicarbonate has been reported by Harrop(a), and Marriott and Howland 

 (see Howland and Marriott (?;)) have frequently observed the development 

 of symptoms of tetany in infants during the course of bicarbonate treat- 

 ment. Palmer and Van Slyke suggest that the administration of sodium 

 bicarbonate should be controlled by determinations of the plasma carbon 

 dioxid. The alkali should not be pushed beyond a level of about 70 vol- 

 umes per cent, which represents the level of plasma carbon dioxid at which 

 normal urine becomes alkaline following the ingestion of hicarlx)nate. 



3. Intravenous Infusions to Combat Toxemia. The importance of 

 an abundant intake of fluids in the treatment of acute toxemia is beyond 

 question. The fact, however, that the gastrointestinal tract is the natural 

 route for the absorption of fluid is too often overlooked by the advocates 

 of intravenous therapy. Many intravenous infusions could be dispensed 

 with if a sufficient supply of fluid by mouth and by rectum was available. 

 In other words, the failure to recognize the insufficiency of the fluid 

 supply, as well as the excessive loss of fluid that may occur as a result of 

 sweating in a given case, often results in the clinical state for which intra- 

 venous infusions become necessary. It is surprising how rapidly and 

 how much fluid may be absorbed from the alimentary tract. When fluid 

 depletion prevails, normal saline, isotonic glucose solution, or tap water, 

 in amounts cf 300 to 400 c.c. may be given by rectum every hour for four 

 or flve doses, and may be repeated every three hours thereafter if neces- 

 sary. It should be recognized that many of the conditions requiring 

 increased fluids are ably met by means of absorption from the alimentary 

 canal, and that in many cases in which intravenous infusions are given, 

 the absorption of fluid from the intestine is a valuable adjunct in 

 treatment. 



In the event of failure to maintain a sufficient fluid intake by other 

 routes, intravenous infusions in toxemic states should be frequently given. 

 There is a popular belief that intravenous injections of various solutions 

 are capable of washing out toxins from the blood stream and indirectly 

 from the tissues as well. The procedure has been used to diminish the 

 toxemia of pneumonia, typhoid fever, etc. Enriquez has reported good 

 results from the intravenous use of hypertonic glucose solution in the 



