ACIDOSIS.
As pointed out by J. 'Thomson and Langmead, the terms Acidosis, Acetonxmia, and Acid-Intoxication have led to much confusion. The mere presence of acetone in the blood or urine is only of significance because of the nearly constant accompanying presence of diacetic and 0-oxybutyric acids which constitute the real danger to life. (fence the terms acetonmia and acidosis, indicating a condition which may be symptomless, may well give way to the more distinctive term Acid intoxication, with its characteristic acetone breath, abnormal respiration, air hunger, bright red lips, cyclical vomiting, and restlessness passing into coma.
Whether the condition arises during the course of diabetes, poisoning by salicvlates or phosphorus. or follows chloroform or ether aniesthesia, or supervenes during the final stages of prolonged septiemmic states, the principle of the treatment is the same and may be summed up in the word i1lkalies. After the administration of a smart saline purgative, Bicarbonate of Soda in one dose of too grs., repeated in half this amount every hour or every two hours, should be given in plenty of water. If vomiting he present, z oz. of the alkali in pint water should be ad ministered by the bowel and repeated in half this amount every four hours. Where the symptoms do not yield speedily to these measures resort must be had to intravenous injection of large doses of the soda salt. Lepine recommended Goo grs.,dissolved in 8 oz. water to be in jected into a vein slowly during half an hour. Citrate of Potash formed by giving Bicarbonate with lemon juice may advantageously be sub stituted at a later stage. The diet should consist of skimmed milk and
carbohydrates. These latter, even in diabetic cases, may be the danger period. Fats should be avoided.
The cyclical or recurrent vomiting of infancy or childhood is often a grave or fatal form of acid-intoxication. The cause being some perversion of the normal metabolic processes due to errors probably in feeding, the correc tion of the diet is of primary importance. Barley water to which one third of its bulk of skimmed milk is added, the whole being well sweetened with Lactose, should be given at short intervals alternating with so to 3o gr. doses of Sodium Bicarbonate according to age. Rectal administra tion of the alkali where the stomach fails to retain it and in severe cases large hypodermic doses of a t in so solution may be lodged in the loose cellular tissue, or in extremity to per cent.,Dextrose or 4 per cent. solution of the soda salt may be given by the veins. In older children Goppert's plan of making the patient distend his stomach by drinking as large a quantity as possible of weak alkaline aerated water sweetened with sugar often arrests vomiting; even when it fails to accomplish this the procedure acts like a lavage of the stomach. In all cases minute doses of Calomel in a little powdered sugar laid on the tongue and washed down with a teaspoonful of weak barley water are beneficial through the antiseptic action of the drug upon the bowel contents. Morphia may be given in the presence of great restlessness, but it must be always used with caution.