The Rôle of Colloid and of Saline in the Treatment of Shock 12

Winkler, Alexander W.; Danowski, T. S.; Elkinton, J. R.

doi:10.1172/jci101700

Cited by 16 publications

(3 citation statements)

References 12 publications

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“…It has been shown that, within certain limits of time, shock produced by acute salt depletion can be completely, or almost completely, reversed by the simple replacement of the salt deficit with hypertonic solutions of saline (13). It has been found, however, that the use of colloid solutions together with replacement of salt provides a distinct margin of safety (14). Hence blood or plasma should be administered in addition to salt solutions in treating salt depletion shock.…”

Section: Discussionmentioning

confidence: 99%

Biochemical and Hemodynamic Changes Following the Subcutaneous Injection of Glucose Solution 1

Danowski¹,

Winkler²,

Elkinton³

1947

J. Clin. Invest.

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It is well known that the loss of extracellular electrolyte may contribute to or even produce cardiovascular collapse. This is manifest in its most striking form in the crisis of Addison's disease (1), in diabetic acidosis and coma (2, 3) and in patients losing large amounts of fluid from the gastrointestinal tract (4,5). In these conditions the losses of the sodium ion, the chloride ion, and water are often the primary and sole cause of circulatory collapse. The chain of events which ends in clinical shock following salt depletion has been experimentally studied (6, 7). Abstraction of salt from a healthy animal via the peritoneal route according to the Darrow-Yannet technique (8) produces hypotonicity of the extracellular fluid. Water then moves into the cells in response to osmotic forces. The consequent decrease in extracellular fluid volume occurs in both the interstitial fluid and the plasma. Diminution in the latter. is readily detected by the rise in the hematocrit and in the concentration of the total serum protein.It is of particular significance that some of the circulating plasma protein is lost and that in terms of proportionate change, the plasma volume diminishes much more than does the extracellular fluid as a whole (7). These alterations in the composition of the fluid in the extracellular and intracellular compartments are an invariable accompaniment of salt depletion. If acutely induced, and of sufficient magnitude, the loss of salt results in a shock state akin to that seen following burns, trauma, or hemorrhage (9). The circulation slows and the venous pressure falls. These changes are associated with a diminished cardiac output (7). If untreated, death ensues.It seems highly probable that during absorption of a glucose hypodermoclysis salt is removed from the circulation in a manner identical with that ob- served following the injection of fluid intraperitoneally. Moreover, it has been recognized clinically that the subcutaneous administration of nonelectrolyte-containing fluid to certain patients may precipitate circulatory collapse and death. This has been noted in particular in patients with mercury poisoning and with diabetic coma (10, 3). Inasmuch as these conditions are known to be frequently associated with some measure of antecedent salt and water loss, it is possible that the shock state is precipitated by further salt depletion during glucose hypodermoclysis (11). Since the parenteral administration of glucose solutions to all types of patients, even those on the verge of cardiovascular collapse, is a commonly accepted procedure, the biochemical and hemodynamic changes which occur have been studied experimentally and are reported in this paper. It has been found that the subcutaneous administration of a sufficient volume of non-electrolyte-containing fluid usually produces salt depletion, and that this can result in peripheral vascular collapse. MATERIALS AND METHODSThe effects of glucose solutions on circulatory efficiency have been studied in animals and in human patients in the ...

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Section: Discussionmentioning

confidence: 99%

Biochemical and Hemodynamic Changes Following the Subcutaneous Injection of Glucose Solution 1

Danowski¹,

Winkler²,

Elkinton³

1947

J. Clin. Invest.

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“…Thus in sodium depletion states the administration of sodium salts as such is far more certain (38,39). The resin could be employed, as indicated by our data, to remove potassium.…”

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confidence: 87%

Probable Clinical Utility of Cation Exchange Resins

Greenman¹,

Peters²,

Mateer³

et al. 1951

J. Clin. Invest.

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“…As sodium and chloride ions enter the intraperitoneal fluid, water moves into the cells in response to osmotic forces. Diminution of the volume of extracellular fluid and plasma, swelling of the cells, and generalized hypotonicity are the inevitable end results (1,2,3). Since these changes occur rapidly and almost simultaneously, it is difficult to ascribe the primary causative role in the circulatory collapse which ensues to any one factor.…”

mentioning

confidence: 99%

The Importance of Volume and of Tonicity of the Body Fluids in Salt Depletion Shock 1

Elkinton

Winkler²,

Danowski³

1947

J. Clin. Invest.

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It is not known whether the deterioration in circulatory efficiency which follows sodium chloride loss is related primarily to the hypotonicity, to the changes in the volume of fluid in the various compartments, or to both. In experimental salt depletion produced by means of the intraperitoneal injection and subsequent removal of glucose solution, both of these factors invariably coexist. As sodium and chloride ions enter the intraperitoneal fluid, water moves into the cells in response to osmotic forces. Diminution of the volume of extracellular fluid and plasma, swelling of the cells, and generalized hypotonicity are the inevitable end results (1, 2, 3). Since these changes occur rapidly and almost simultaneously, it is difficult to ascribe the primary causative role in the circulatory collapse which ensues to any one factor. It is conceivable, on theoretical grounds at least, that all of these changes are important. It is quite possible, for instance, that the hypotonic and swollen cells of the cardiovascular system become inefficient, while the blood thickens and becomes more difficult to move through the vessels.To clarify the relative significance of each of these changes in the production of salt depletion shock, further experiments have been conducted in which hypotonicity and the state of hydration of extracellular and cellular fluid have been altered in directions other than those seen in ordinary salt depletion. MATERIALS AND METHODSA. Dilution of the body fluids in nephrectomized animals. The effects of an infusion of 5 per cent glucose solution on the composition of the body fluids and the efficiency of the circulation were studied in 3 nephrectomized dogs on the day following removal of the second kidney. The B. Restoration of isotonicity by urea diuresis in saltdepleted animals. Two other dogs were first depleted of salt by the standard technique of injecting 5 per cent glucose solution intraperitoneally, 100 ml. per kgm., and withdrawing it after 3 to 4 hours (1). An overnight diuresis was then induced in these animals by means of an intravenous injection, 350 ml. of a 15 per cent solution and 300 ml. of a 10 per cent solution of urea in 5 per cent glucose, respectively. In one of these animals the effects of a subsequent infusion of hypotonic saline, 0.6 per cent, were investigated.In all studies in Groups A and B, movements of water from the extracellular compartment were calculated from changes in the chloride space (4). Alterations in the plasma volume were estimated from changes in the relative blood cell volume and in the hemoglobin concentration of arterial blood (1). Changes in the volume of cell water were obtained by subtracting the increments or decrements of extracellular water from the changes in total body water. These later values were calculated from the changes in body weight; in the periods lasting ?0 hours the weight change was corrected for water of oxidation according to the metabolic mixture (4). The possibility of transfers of sodium and potassium between extracellular an...

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The Rôle of Colloid and of Saline in the Treatment of Shock 12

Cited by 16 publications

References 12 publications

Biochemical and Hemodynamic Changes Following the Subcutaneous Injection of Glucose Solution 1

Biochemical and Hemodynamic Changes Following the Subcutaneous Injection of Glucose Solution 1

Probable Clinical Utility of Cation Exchange Resins

The Importance of Volume and of Tonicity of the Body Fluids in Salt Depletion Shock 1

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