By M.D. Esben Kirk
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Additional resources for Acidosis. Clinical Aspects and Treatment with Isotonic Sodium Bicarbonate Solution
The following case record, communicated by Dr. Weatherhill, besides giving a convincing impression of the importance of the intravenous treatment of cholera also affords a striking example of the energy and solicitude of English practitioners 110 years ago. Case record No. 5. Cholera. « Lancet, 2: 688, 1831-32). A blacksmith, aged 29, was seized with symptoms of cholera during his work on August 18, 1832. He was at once put to bed in his home and already a few hours later he felt better. After 3 days he felt quite well and — without the permission of his physician -— got up and came downstairs to dine with his family.
In daily life acidosis occurs so frequently that it will be familiar to everybody, for during hard bodily work a considerable lactic acid acidosis will set in. The acidosis occurs especially during brief spells of hard work in which t h e production of lactic acid during the muscular work is so great that it cannot be removed as fast as it is formed. The lactic acid in the muscles is produced from glycogen, which during the contraction of the muscles is split up into lactic acid. In conditions in which the supply of oxygen to the muscular tissue is sufficient, 4 / 5 of the lactic acid produced will be reconverted into glycogen at the end of the contraction, while the remaining i/ 5 undergoes combustion to carbon dioxide and water.
First breathing grew more easy, then the circulation improved, and t h e skin became warm. This improvement which, in Dr. Weatherhill's words, was »truly delightful«, only lasted for half an hour, however, when he began to sink again. Another 2 litres of solution were therefore injected with the same good effect; the patient was again restored to consciousness and felt well (»he was himself again«). At 10 o'cl. a. , 2 hours after the last injection the condition had again become grave. The patient perspired profusely, the extremities were cold, and there were symptoms of incipient collapse.