TOTAL ACID-BASE EQUILIBRIUM OF PLASMA IN HEALTH AND DISEASE: VI. Studies of Diabetes.

In the preceding article (1) it was pointed out that one of the electrolyte disturbances most frequently encountered in the serum of patients with nephritis with uremia was deficiencyof the total electrolyte (base) concentration of the serum and that this was apparently instrumental in the determination of acidosis (reduction of bicarbonate) in a certain and rather large proportion of cases. It was also pointed out that chloride as well as bicarbonate was diminished in most of the cases with deficient base. Statistically a definite correlation between Cl and base reductions was demonstrated. It was also shown that slightly better correlation was obtained between Cl + HCO3 and base, indicating that base reductions were compensated by both Cl and HCO3. The correlation between base and HCO3 was not clear because HCO3 also yielded base to other acids, including Cl, which at times, accumulated in excess in the serum. This is an illustration of what Gamble (2) has called the "mendicant position of bicarbonate." It was stated that reductions of Cl and base were encountered usually when: (a) vomiting was a serious symptom or (b) patients had received limited amounts of salt and had excreted large amounts of fluid. It was suggested that these patients have a tendency to waste salt through the kidneys and also, possibly, by extrarenal channels. The present article is intended to present in more detail the evidence on which these hypotheses were based.