The Acidosis of Acute Diarrhea in Infancy

Hamilton, Bengt

doi:10.1001/archpedi.1929.01930080090009

Cited by 11 publications

(4 citation statements)

References 6 publications

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“…The dominant alteration during dehydration in our series was in the direction of a lowering of concentration of fixed base, chloride, and bicarbonate and an increase in concentration of protein. In a series clinically similar to ours, Hamilton, Kajdi, and Meeker (3) found that 56 per cent showed a subnormal concentration of total base, 40 per cent a low chloride value. The higher figures for total fixed base and for chloride which Hartmann (2) reported may have depended on the fact that his series consisted mainly of patients who were much sicker than ours and who may well have suffered a true anhydremia.…”

Section: Methodssupporting

confidence: 81%

“…Another course is open to us, in that we can compare the values found during dehydration with normal values obtained with the same technique (3,6), the normal blood volume being calculated on the basis of the body weight. Since this allows us to indude patients in whom determinations were made during dehydration but whose death prevented our obtaining a second set for comparison, the series can be augmented to 19 cases.…”

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confidence: 99%

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Blood Volume and Plasma Electrolyte Changes in the Dehydration of Infants

McIntosh

Kajdi²,

Meeker³

1930

J. Clin. Invest.

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In a general review of the subject of anhydremia published in 1923, Marriott (1) brought out several of the phenomena which had been shown to accompany severe clinical dehydration: an increase in the proportion of the total solids and in the dried weight of a unit volume of blood, an increase in its specific gravity, in red cell count and hemoglobin, and in the concentration of the serum proteins. He showed also, however, that when deprivation of fluid, either from lack of intake, from vomiting, or from diarrhea, persisted over a long period of time, a lowering of total solids, red count, and hemoglobin ensued, which was attributed to breakdown of body protein with the liberation of bound water. All of these phenomena might occur at a time when the plasma volume was subnormal, and consequently an investigation of the concentration of these substances in a unit volume of blood was shown to be of limited value in the study of the water economy as a whole in dehydration. Although these considerations emphasized the fatuity of placing reliance on the indirect evidence afforded by changes in the concentration of blood constituents and the necessity for direct investigation of blood and plasma volume changes in dehydration, such direct determinations have been singularly infrequent. Marriott mentioned some in a general way, but did not fully report his data.A number of studies made since 1923-for example, those of Hartmann (2) and of Hamilton, Kajdi and Meeker (3)-on the serum or plasma concentration of electrolytes in dehydration accompanying the infections and digestive disorders of infants have shown that a lowering of the total electrolyte concentration is, in fact, rather more com-333 BLOOD VOLUME AND ELECTROLYTES mon than an increase; and even when dehydration was brought about experimentally by reduction of the water intake, Schiff, Bayer, and Fukuyama (4) were unable to change the concentration of serum total fixed base beyond the limit of error of the method used. If, then, a lowering of serum electrolyte concentration of this kind, or even if no change in concentration occurs, one must abandon the concept that loss of water alone from the blood is the primary event in the development of dehydration, since this would only act to bring about a higher concentration of electrolytes. This actual lowering of serum electrolyte concentration in dehydration appeared to Hartmann (2) of sufficient importance to cause him to postulate that loss of electrolyte from the circulation might occur to an extent that required the body to retain nonprotein nitrogen constituents for their osmotic action so that the normal osmotic pressure of the plasma might be maintained. If water alone had been lost to excess, no such difficulty would have existed, for the osmotic pressure of the plasma would by that measure be increased. The lowering of serum electrolyte concentration could theoretically be brought about by dilution of the blood, though in view of the loss of body weight and the obvious loss of water from the body as a whole, ...

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Section: Methodssupporting

confidence: 81%

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confidence: 99%

Blood Volume and Plasma Electrolyte Changes in the Dehydration of Infants

McIntosh

Kajdi²,

Meeker³

1930

J. Clin. Invest.

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“…The observations of other workers on the chloride content of the plasma in dehydration also show that it may be high, normal or low. Some (Hartmann, 1928;Hoag and Marples, 1931;and Pincus and Kiser, 1931) found a large number of high values similar to those discussed above, whereas others (Darrow and Buckman, 1928 ;Hamilton et al, 1929 ;McIntosh et al, 1930;and Cooper, 1937) have reported a larger proportion of normal and low values. Boyd (1926) reports a series of sixty-six cases of acute intestinal intoxication of which thirty-three had normal chloride values, twenty-one were below normal and twelve above normal.…”

Section: Chemical Featuresmentioning

confidence: 81%

“…This affects the output of excretory products and electrolytes as well as water, so that the kidney is prevented from getting rid of excess acid radicles, of which the most important is the chloride. The significance of this renal insufficiency is stressed by Hamilton et al (1929), Hartmann (1929), Marriott (1934), and Marples et al (1934.…”

Section: Chemical Featuresmentioning

confidence: 98%

The changes in the blood produced by dehydration in infancy

Aldridge¹

1941

Archives of Disease in Childhood

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It is the purpose of this and a subsequent paper to record the result of a study of the effects of dehydration and the treatment of that condition carried out in a series of fifty-one infants in the years 1937-1938 during the tenure of a Caroline Harold Fellowship of the University of Birmingham. The objects of the investigation were: To determine the indications for the administration of fluid parenterally; the best form of fluid to use; the route by wl'ich it should be given ; the value of haematological and biochemical examination in forming a decision as to the most suitable fluid to use. In this paper the changes in the blood produced by dehydration are chiefly considered, and the subsequent paper is devoted to the treatment of that condition.The majority of the children in this series were suffering from gastro-enteritis, but some were investigated before and after operation-chiefly for pyloric stenosis in infants and for hare lip and cleft palate in older children-and others who, on account of haemorrhage or for other reasons, were given blood transfusions. The investigations carried out on the blood comprised red cell counts, haemoglobin estimations, haematocrit readings and the estimation of plasma chloride and plasma protein concentrations. For these purposes very small amounts of heparinized blood (less than one-third of a cubic centimetre) were collected from the subject's heel or ear in tubes especially designed for the purpose; it was thereby possible to carry out daily examination of the blood over long periods without causing an appreciable loss of blood to the patient.

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Acid-Base Status in Dehydration Accompanying Diarrhea in Infants

Hoag¹

1931

Am J Dis Child

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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

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The Acidosis of Acute Diarrhea in Infancy

Cited by 11 publications

References 6 publications

Blood Volume and Plasma Electrolyte Changes in the Dehydration of Infants

Blood Volume and Plasma Electrolyte Changes in the Dehydration of Infants

The changes in the blood produced by dehydration in infancy

Acid-Base Status in Dehydration Accompanying Diarrhea in Infants

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