Relation between Alkalosis and Tetany. 231 



sodium hydroxide and other alkalies into dogs and rabbits and 

 to those of Scott 1 who injected sodium carbonate into decerbrate 

 cats. Both obtained respiratory effects and the latter believed he 

 obtained marked changes in the reaction of the blood but neither 

 mention any sign of neuromuscular symptoms resembling tetany 

 or convulsions. Hougardy found that the slightest excess of 

 alkali killed his animals promptly. 



Scott employed smaller doses and a slower rate than were 

 used in the present experiments and obtained much lower values 

 for total C0 2 content of the blood than are here reported for 

 plasma. But the changes in hydrogen ion concentration he re- 

 ports are at least as great as those in the present experiments. 

 The validity of his conclusions as to the specific function of the 

 bicarbonate ion as a respiratory hormone rests entirely upon the 

 accuracy of his determinations of the hydrogen ion concentration. 

 From a priori considerations and from the results here reported it 

 would appear that the dialysis colorimetric method employed by 

 Scott gives too high P H values particularly under the high CO2 

 tensions obtaining after the injection of sodium carbonate. The 

 significance of the bicarbonate ion as a respiratory hormone is, 

 therefore, highly questionable. 



Within the last few years there have been a number of reported 

 cases, and probably a much larger number of unreported cases, 

 of tetany appearing in patients after the intravenous injection of 

 sodium bicarbonate for therapeutic purposes. A high C0 2 com- 

 bining capacity, 80 volumes per cent, or more, has been observed 

 and the phrase "alkalosis" has been accepted as explaining the 

 appearance of the symptoms. Palmer, Salvesen and Jackson 2 re- 

 gard it as dangerous to administer sodium bicarbonate by mouth 

 in amounts greater than those required to produce the first signi- 

 ficant change in the reaction of the urine. Such caution would 

 appear to be needless. Patients with gastric hyperacidity may 

 take sodium bicarbonate in amounts sufficient to make the urine 

 alkaline for days at a time without any sign of tetany. The ap- 

 pearance of an alkaline urine is not a danger sign. Rather is it an 



1 Scott, R. W., American Journal of Physiology, 1917, xliv, 196; 1918, xlvii, 43. 



2 Palmer, W. W., Salvesen, H., and Jackson, H., Jr., Journal of Biological Ckem- 

 is try, 1920, xlv, 101. 



