INDICATIONS OF ACID INTOXICATION IN ASIATIC 



CHOLERA. 



By Andeew Watson Sellabds and A. O. Shaklee. 



(From the Biological Laboratory, Bureau of Science, and the 



Pharmacological Laboratory, College of Medicine and Swr- 



gery, University of the Philippines, Manila, P. I.) 



The position of the theory of acid intoxication in clinical medicine 

 rests almost entirely upon the investigations in one disease, namely, 

 diabetes. More or less prominent symptoms of acid intoxication may 

 develop in some other conditions, such as starvation, the toxaemia of 

 pregnancy, and after general anaesthesia, but the knowledge derived 

 from these sources is of relatively minor importance when compared 

 with that obtained from diabetes. However, there are certain features 

 in Asiatic cholera which afford an interesting opportunity for the study 

 of acid intoxication. 



An increase in the daily excretion of sulphuric acid and of ammonia in the 

 urine together with the presence of (3-oxybutyric acid has been reported by Hoppe- 

 Seyler.(l) In a concluding note of this same article, Quincke reports a case of 

 cholera in which 30 grams of sodium citrate were given by mouth and by rectimi 

 in the course of three days, but during this period the urine remained acid. V. 

 Terray, Vas and Gara(2) found a considerable increase in the excretion of sul- 

 phuric and of phosphoric acids and also of ammonia and acetone. Acetoacetic acid 

 was often present. 



Perhaps the most important feature in cholera which bears upon 

 acid intoxication is the increased tolerance of patients for alkalies. The 

 intravenous injection of sodium bicarbonate in relatively large quan- 

 tities often fails to render the urine alkaline. In the interpretation of 

 this tolerance, the anuria of cholera, following the excessive loss of 

 fluid by rectum, offers a possible complication. The alkalies intro- 

 duced into the body might be excreted by other channels, for example 

 by rectum. However, if quantities of 30 to 60 grams were being ex- 

 creted into the intestine one would almost expect that the kidney also 

 would excrete at least enough alkali to change the reaction of the urine. 

 Moreover, if the alkali is retained in the body during the period of 

 anuria, there is the possibility that it might be neutralized by sub- 

 stances other than acids, such as serum albumins for example. There- 

 fore, in Table I the intervals between the injection of alkali and the 

 first secretion of urine have been included. Five control cases are also 



added. 



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