The Treatment of Dehydration, Acidosis and Alkalosis

Parenteral Use of Water, Dextrose, Electrolytes, Fat and Vitamins

“…Nondiabetic ketosis, nephritis, burns, Addison's disease, heat prostration and heat cramps are other causes not infrequently seen. 20 The presence of the severe symptoms and signs of dehydration so often indicate the failure to make an early diag¬ nosis and to employ proper treatment. alterations mentioned are those occurring with ketosis, with distur¬ bances of renal function in nephritis and in burn patients.…”

“…"Working approxi¬ mates" or "estimates" are better terms for the initial calculation of howmuch and what kind of fluid to give in a particular instance, and from that point modifications are made according to the response of the patient and further laboratory studies. Whenever possible, information on water and electrolytes should be of a usable nature and should be presented to physicians in a manner to aid them in the care of their patients, and in the development of present information it is fitting to pay tribute to the important obser¬ vations of O'Shaughnessy,1 Schmidt,2 Fagge,3 Stadelmann,4 Rogers,5 Nichols and Andrews, 6 Trout,7 Hartwell and" Hoguet,8 Henderson,9 Macallum, 10 Matas, 11 Gamble,12 Orr and Haden,13 Van Slyke,14 Peters,15 Hartmann, 16 McCance, 17 Newburgh,18 Coller,19 Darrow,20 Butler and Talbot.21 For those wishing to review basic material on water and electrolyte balance I highly recommend Gamble's lecture syllabus on the chemical anatomy, physiology and pathology of extracellular fluid.22 WATER AND DEXTROSE Water comprises about 70 per cent of the total body weight23 and is distributed in two physiologic compartments, the intracellular and the extracellular. The intracellular fluid makes up approximately 50 per cent of the total body weight and the extracellular about 20 per cent.…”

“…The effective osmotic pressure in the intracellular compartment is largely due to potassium, while in the extracellular fluid sodium takes its place, and the distribution of these two bases is the chief factor controlling the distribution of body water. 20 The components of normal daily water exchange with some average figures are shown in table 1. As can be seen, water becomes available from fluids drunk and from food eaten, the latter providing both its water content and water of oxidation as it is burned for energy.…”

Diabetic Acidosis

“…The usual symptoms are (1) increase of the cardinal diabetic symptoms of polyuria and polydipsia, (2) drowsy restlessness, (3) abdominal symptoms of nausea and vomiting and pain which may or may not be associated with tenderness, (4) coincidental development of Kussmaul breathing, (5) increasing drowsiness and (6) unconsciousness. It cannot be emphasized too strongly that these symptoms do not necessarily occur in this order and that coma may not develop even with a relatively low carbon dioxide-combining power.…”