ACID INTOXICATION IN ASIATIC CHOLERA. 73 



The patient who died under treatment Mitli bicarbonate alone was a 

 child eleven years old admitted in partial collapse. 



Although in the control series there were only four deaths in which 

 symptoms of uraemia were present, yet because of the constancy of ure- 

 mia, its absence is suggestive in the group of cases treated with bicarbon- 

 ate and serum. Theoretically, the serum might prevent the development 

 of uraemia if it could abort the infection. 



There was no evidence to indicate that the serum was responsible for 

 the absence of uraemia. In large epidemics where senmi has been used 

 extensively, nothing has been reported to show that the incidence of ura?- 

 mia is lessened. The number of cases, treated without serum, namely 

 fifteen, represent those which were less severe; but since even the mild 

 cases are not always free from uraemia, this group would suggest that it 

 was not the serum which prevented the development of this complication. 



One patient (number 10), in the bicarbonate series, developed symptoms of 

 uraemia. This ease was admitted in complete collapse and responded poorly both 

 to the injections of fluid and also to the serum, 200 cubic centimeters of which 

 were used. During the first eighteen hours, 6 liters of 0.5 per cent bicarbonate 

 ^^'ere injected. At the end of the first day, during which time only 15 cubic 

 centimeters of urine were obtained, the concentration of the sodivim bicarbonate 

 was increased, 1 liter of a 1.5 per cent solution being injected. Eight hours later, 

 140 cubic centimeters of urine were obtained by catheter, but this rate of excre- 

 tion soon diminished and after nine hours an additional 15 grams of bicarbonate 

 in 1 liter of water were given intravenously. After a twelve-hour interval only 

 70 cubic centimeters of urine were secured. The patient was not clear mentally, 

 the restlessness was increasing, and the general condition was not good. A si.xth 

 injection of bicarbonate was given consisting of 2 liters of a 1.5 per cent solution. 



As soon as the injection was well started, the patient complained severely of 

 pain throughout the body and of cramps in the muscles. After the administra- 

 tion of one liter, there was considerable contraction and twitching of the muscles, 

 which Was especially noticeable in the extremities. The rigidity of the muscles 

 did not entirely pass away urftil after eight hours. This is the only case in the 

 series M'hich developed muscular twitehings. A specimen of blood taken at that 

 time showed a trace of haemolysis, although none was observed after the use of 1.5 

 per cent sodium bicarbonate in a number of other cases. At this time, eight 

 hours after the injection, no urine had been obtained and the symptoms of 

 uraemia persisted. In view of the pronounced reaction which had followed the 

 last injection it did not seem advisable to continue the injections of alkali. This 

 case had received a total of 90 grams of sodium bicarbonate in two days. The 

 patient had certainly passed the stage of collapse and as the anuria had not 

 yielded to the injections of alkali, it apparently constituted a definite exception 

 to the other cases. However, after an additional four hours 120 cubic centimeters 

 of urine were obtained by catheter, and in the next twenty-four hours 1,200 cubic 

 centimeters. The mental condition rapidly returned to normal after the excretion 

 of uxine commenced. 



