TOTAL ACID-BASE EQUILIBRIUM OF PLASMA IN HEALTH AND DISEASE

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Abstract
The cases used in electrolyte studies were utilized for the chloride determination. The author concludes that hypochloremia and deficiency of base in serum in advanced nephritis are the results of A tendency for base and chloride to be excreted in the urine when serum chloride has fallen below the level which, in the normal individual determines achloruria and of vomiting which attains its effect less by producing direct chloride loss than by interfering with salt intake. The vomitus in uremia contains little free HC1. A considerable amount of the chloride in such vomitus exists in the form of basic chloride. Although the concentration of chloride in vomitus remains high even in the face of advanced hypochloremia the total chloride loss by emesis is usually small compared with that in the urine. Considerable quantities of chloride may be lost in the feces in certain cases even if there is no diarrhea. There is no necessity of postulating any peculiar redistribution of chlorides in the body to explain the hypochloremia. The distribution of chloride is discussed as are the relations of changes in body water and salt content. It is pointed out that hypochloremia and low serum base are usually attended by anhydremia and general dehydration. The therapeutic implications of these findings are discussed.

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