PEDIATRICS Vol. 3 No. 2 February 1949, pp. 129-156
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DISTURBANCES OF WATER AND ELECTROLYTES IN INFANTILE DIARRHEA

DANIEL C. DARROW M.D.1, EDWARD L. PRATT M.D.2, JAMES FLETT JR. M.D.1, ALICE H. GAMBLE M.D.1, and HILDA F. WIESE M.D.1

1 The Departments of Pediatrics, Yale University School of Medicine, New Haven, Conn., and the University of Texas School of Medicine, Galveston, Tex.
2 The Departments of Pediatrics, Yale University School of Medicine, New Haven, Conn., and the University of Texas School of Medicine, Galveston, Tex., Senior Fellow in Pediatrics of the National Research Council acting for the National Foundation for Infantile Paralysis, Inc.

Balances of water, nitrogen, chloride, sodium, potassium, phosphorus and calcium are reported in eight cases of diarrhea.

Average deficits/kg. in severe dehydration due to diarrhea are H2O, 125 gm.; Cl, 9.2 mM; Na, 9.5 mM; and K, 10.4 mM. These figures may be about 10% too high for H2O, Na and Cl because of overexpansion of extracellular fluids in some cases.

These findings, especially the approximately equal retentions of Na and Cl during recovery, indicate 1. that intracellular Na is slightly high during dehydration in many cases; 2. that NaCl without NaHCO3 should suffice to restore all deficits of Na and Cl; 3. that acidosis is explained chiefly by deficit of K which leads to transfer of extracellular Na into the cells during dehydration; 4. that fluids used to replace deficits of H2O and electrolyte in diarrhea should contain K as well as Na and Cl; 5. that administration of NaHCO3 without potassium salts so as to restore rapidly the concentration of serum HCO3 in acidosis is likely to aggravate the abnormality in cellular composition and may produce alkalosis and low concentration of K in serum.

Losses of H2O as sweat are frequently 50 ml./kg./day; the maximum measured was 100 ml./kg./day. Losses of H2O in stools are frequently 50 ml./kg./day; maximum measured was 85 ml./kg./day. Nitrogen losses are rapidly replaced when milk feedings are instituted even at low caloric intakes. In the development of dehydration, losses of water in sweat are quantitatively as important as losses in stools.

Relation of these findings to treatment of infantile diarrhea is discussed.

Submitted on June 30, 1948




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