THE INTRA VENOUS INJECTION OF FLUIDS 801 



once injected did not produce fever, but tended to cause a fall in tempera- 

 ture. Samples of the same water, collected and sterilized with all the 

 usual precautions and allowed to stand, produced fever upon injection. 

 The cause of such a reaction is unexplained. These authors recommend 

 that water for intravenous use should he recently distilled and sterilized 

 before injection, as the only reliable method of avoiding fever. All water 

 used for infusion purposes should be distilled from, water containing as 

 little organic material as possible, and sterilized at once after distillation. 

 It should then be preferably stored on ice if not immediately used. 



The bad results that have been reported following the use of gum- 

 saline can generally be explained by investigation of the individual cases. 

 They have been found to be due to the use of impure gum acacia, to im- 

 proper storage of gum-saline after it has been made up for use, and, as 

 DeKruif showed, to gross infection of the solution. Gum acacia is 

 protein-free and has been demonstrated by Bayliss and DeKruif to be 

 free from anaphylactic phenomena. Before use in man, the toxicity of 

 the stock gum acacia should be tested in cats or guinea pigs. When all 

 precautions have been observed in the preparation of gum-saline, chills 

 have occurred in 5 per cent to 10 per cent of cases after its injection into 

 the circulation. The failure to test the toxicity of the stock supply of 

 gum, and to observe the other usual precautions, has led to some fatalities 

 from its use. 



In the case of sodium bicarbonate injections, reactions may consist of 

 convulsions or complete collapse, according to Joslin. The production 

 of tetany after bicarbonate injections has already been discussed. 

 Harrop(a) has called attention to the danger of the intravenous use of 

 bicarbonate when the excretory function of the kidneys is impaired, and 

 especially when oliguria or anuria is present. 



Chills and fever occurring after intravenous injection of normal saline 

 are usually the result of carelessness in preparation of the solution. The 

 practice of employing as "normal saline'' a solution of boiled water plus 

 an indefinite quantity of salt is not to be advised. 



Preparation of Infusion Solutions and Technic of 



Administration 



If the general principles concerning the character of water, purity of 

 substances employed, etc., already discussed are followed, no special points 

 remain to be mentioned in the preparation of solutions for intravenous use, 

 The exception to the general rule concerns the preparation of gum-saline, 

 which, owing to difficulties of nitration of the gum, requires special technic. 

 A full description of the method of preparation of gum-saline is given by 

 Telfer. 



