CHANGES IN TOTAL CHLORIDE AND ACID-BASE BALANCE IN GASTROENTERITIS FOLLOWING TREATMENT WITH LARGE AND SMALL LOADS OF SODIUM CHLORIDE

Abstract

Seventeen infants with acute gastroenteritis have been studied. These patients were divided into 2 groups, 1 receiving high sodium loads (average 18 mEq./kg.) and the other low loads (6 to 7 mEq./kg.) during the first 24 hours following admission to the hospital. Adequate fluids and potassium were also administered and the acidbase balance, serum electrolyte concentrations, and total chloride were obtained in most instances at the time of admission, at 24 hours and at 72 following admission. From 24 hours to 72 hours maintenance fluid and electrolyte were given to all patients. Patients receiving high initial loads of sodium demonstrated persistent acidosis at 24 hours and a trend towards hypokalemia and/or metabolic alkalosis at 72 hours. The administration of low initial sodium loads was associated with a more consistent reduction of acidosis at 24 hours and the finding of normal serum chemical values at 72 hours. It is pointed out that if diarrhea does not abate after admission, the administration of low sodium loads does not restore hydration or acid-base balance. Progressive determination of total body chloride and body weight demonstrated large increments in body chloride in patients receiving high sodium chloride loads. This increment persisted in 3 patients and was associated with edema, and probable cell water subtraction. It is considered that amounts of sodium of similar magnitude to the known deficits should be given initially in gastroenteritis except in the presence of hyperelectrolytemia. Other conditions of dehydration require different fluid therapy and sometimes the complete restriction of potassium (e.g., adrenal insufficiency). The results suggest an abnormal increase of total body sodium with sodium loading during circumstances of potassium loss, a contention well supported by animal experiments.