Intravenous injection in wound shock : being the Oliver-Sharpey lectures delivered before the Royal College of Physicians of London in May 1918 / by W.M. Bayliss.

  • Bayliss, William Maddock, Sir, 1860-1924.
Date:
1918
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Licence: In copyright

Credit: Intravenous injection in wound shock : being the Oliver-Sharpey lectures delivered before the Royal College of Physicians of London in May 1918 / by W.M. Bayliss. Source: Wellcome Collection.

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    Alkaline (Bicarbonate) Injections. The recommendation to make use of alkaline solutions assumes that “acidosis” is a potent factor in the phenomena of wound shock. After careful examination of the evidence, I have been compelled to come to the conclusion that the importance of the state has been greatly exaggerated, not only in wound shock but in general. The use of bicar¬ bonate solutions is unnecessary, their effect being better attained by merely raising the blood pressure. Since the question is a much disputed one, a somewhat detailed discussion is advisable. In the first place, as a salt merely, a 4 per cent, solution of sodium bicarbonate, the concentration recommended, has the same effect as a hypertonic solution of sodium chloride, with the same advan¬ tage or disadvantage. But it is not used for this purpose, but to combat “acidosis.” What then do we mean by this statement ? Normal blood contains a certain percentage of sodium bicarbonate and, as Lawrence Henderson (1913, pp. 140-163) has so well shown, can never become more than just faintly more acid than dis¬ tilled water so long as there is any bicarbonate left in it. But the normal bicarbonate content of the blood may be reduced, owing to reaction with non-volatile acids produced in the tissues (lactic, hydroxy- butyric, etc.). When more than a small amount of the bicarbonate has been replaced by the sodium salts of such acids, or when the plasma gives off less than the normal 55 volumes of carbon dioxide when acted on by sulphuric acid in a vacuum, after