Acid-Base Status in Dehydration Accompanying Diarrhea in Infants

Abstract

The syndrome of acute gastro-intestinal disturbances, preceded or accompanied by parenteral infections, causes profound and widespread abnormalities in infants, which are reflected to some degree in changes in the blood. The present methods of investigation are so limited in scope and in their applicability to infants that our conception of the disease is necessarily incomplete and perhaps distorted. In spite of these limitations, studies of dehydration and of the associated acidosis induced by diarrhea, vomiting and refusal of food have extended our knowledge of the condition and have profoundly influenced its treatment.The significance of dehydration was recognized early, and treatment was originally aimed at the relief of this symptom. This object can be most simply achieved by administering large amounts of fluid by mouth. Unfortunately, due to vomiting, it is seldom possible to give the requisite quantities by this route. Hence, it has been necessary to resort to the parenteral use of fluids. Hypodermoclyses of a 0.9 per cent solution of sodium chloride in moderate quantities were used and gave some relief, but, examined in the light of our present knowledge, this fell far short of the ideal treatment. When the significance of the lowered bicarbonate content of the blood was appreciated, intravenous injections of sodium bicarbonate were also used. In the opinion of most workers, these injections proved inadequate in routine treatment. In the concentrations used, they did not supply the necessary fluid and their effect on the acidosis, while beneficial, was only temporary. Fre¬ quently repeated injections in sufficient quantities to control the acidosis involve the danger of tetany or renal lesions.Howland and Marriott,1 in discussing the acidosis of dehydration, mentioned the oliguria and even anuria which may be present. Schloss 2

Infantile Diarrhoea and Vomiting

“…The need for a reliable laboratory or bedside test is great. Much excellent work has been done on the changes in body chemistry occurring in dehydration, in both adults and babies (Hoag and Marples, 1931 ;Aldridge, 1941). Most observers agree that the level of plasma chlorides and proteins in no way indicates the amount of fluid lost.…”

“…Macro-and microscopical evidence of liver damage was found in 6 of our babies on whom post-mortems were performed, in extreme degree in 2 of them. Lately, a good deal of work has been done on diets producing and preventing liver damage (Ravdin et al, 1943;Himsworth and Glynn, 1944). Although various other factors probably cause the initial toxic changes in the livers of babies suffering from diarrhoea and vomiting (e.g., infection), it seems to us that the extreme fatty infiltration often found after death may be at least partly due to protein starvation, especially lack of some of the important amino acids.…”

Urea Clearance in Normal and in Dehydrated Infants

“…A vicious circle is established which can often be removed by restoring normal water metabolism in the body. 31 …”

The Secretion of Urine by Dehydrated and Normal Infants

“…Hartmann (1928) noted that chlorides were raised, and bicarbonate correspondingly reduced, in the plasma of infants whose losses by diarrhoea and vomiting were such that the volume of saline F administered did not relieve their oliguria. Hoag and Marples (1931), however, considered that, except in moribund infants, the oliguria could always be overcome if enough fluid, including large volumes of parenteral saline, was given, and with this Cohen et al (1933) agreed. The latter found in addition that this treatment restored the blood urea to normal.…”