ACID INTOXICATION IN ASIATIC CHOLERA. 75 



of normal serum and 0.5 per cent bicarbonate, and died on the fourth 

 day. 



The death rate was low for the twent3'-two cases treated with bicarbon- 

 ate and serum; imder less favorable circumstances, with cases received in 

 the late stages of the disease, it would certainly be higher. 



CONOLUSIONS. 



The stage of reaction and urajmia in cholera and the acid intoxi- 

 cation of diabetes have the following features in common : 



1. There is a well-marked tolerance for alkalies ; as much as 90 grams 

 in cholera and even 200 grams of sodium bicarbonate in diabetes may fail 

 to render the urine alkaline. In certain stages of both diseases, sodium 

 bicarbonate possesses pronounced diuretic properties. (13) 



2. The relative and absolute amounts of ammonia in the urin-e are 

 considerably increased in both diseases. The administration of alkalies, 

 even in large amounts, sometimes fails to reduce the excretion of am- 

 monia. In cholera, the urine frequently shows a pronounced diminution 

 in the amount and percentage of urea ; some evidence was obtained which 

 suggests that the nitrogen may fail to be excreted as urea or ammonia, 

 even when the organs which form urea are capable of performing their 

 function and the kidney is able to excrete urea. 



3. Preliminary tests indicate that there may be a definite reduction 

 in the carbon dioxide content of the blood in the uraemia of cholera 

 as well as in diabetic coma. 



4. In both diseases,' a diminished alkalinity of the blood has been 

 reported. 



5. The injection of alkalies in the late stages of either disease usually 

 modifies the course without affecting the ultimate termination. The 

 early administration of alkalies in cholera has been effective in pre- 

 venting death from uraemia without any apparent increase in the num- 

 ber of deaths from other causes. 



The exact significance of these analogies can be determined only 

 by a thorough investigation. Acetone and acetoacetic acid have been 

 noted in the urine of cholera cases but no excess of acid has been found 

 which corresponds to the quantities of /8-oxybutyric occurring in dia- 

 betes. Two forms of acid intoxication are distinguished by Naunjni, 

 namely, a relative and absolute type. Loss of alkali from the body 

 apparently may result from a pronounced diarrhoea, this loss giving rise 

 to a relative acidosis. It also is conceivable that there may be an ex- 

 cessive quantity of acid present, resulting in the production of an absolute 

 acid intoxication in cholera. 



