Electrolyte Changes Resulting from Injury

THE importance of adequate fluid and electrolyte therapy is now readily appreciated, and the principles underlying the correction of deficiencies are well established. Everywhere the importance of base conservation by the body is accepted, and measures taken to correct any deficiency of base substance are rigorously applied. We appreciate clearly the difference between a true water deficiency as emphasized by Marriott (1947) and by Darrow and Pratt (1950), and the more serious "hypotonic" dehydration, where electrolyte is lost in amounts at least equivalent to the water loss. Before operation, we realize that the urinary chloride excretion is a more sensitive index of the body chloride state than is the plasma chloride concentration, and we are accustomed to correcting the fluid and electrolyte imbalance before the patient undergoes the additional hazard of the operation itself. The rapid estimation of sodium and potassium by the flame photometer allows us to control therapy from hour to hour and the lag between clinical 59 and biochemical assessment of the patient's condition now scarcely exists. It is important, however, that the routine of replacement therapy should not blind us to the advances which are taking place in this field.