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Les diagrammes suivants illustrent la m^thode. 1 2 3 4 5 6 MICROCOPY RESOlUTION TEST CHART ANSI ond ISO TEST CHART No 2 1.0 I.I Ui |M III Z5 i^ 1^ IJIJJ^ '- ' I p.o mil 1.8 .25 '•4 mil 1.6 ^ -IPPLIED IM/1GE Inc T ^ J A Study of the Buffer Value of the Blood u i, I- !■ \ ^ , M i» I! \I.TI Mii|;r: AM' !. 1 , k( )\\ \ r u I', i:. Mi), Rff-iiiitt-d lidiii ilh' . Ill /ii:r.« tif liitciiHil Mi'iliiiiu- I III! .\>." l-Vr II'v'-VM »\n ("II'IV livr N'nllTM Dfahp'.kn Strift 1-1, A siru\ (ji 111' J;ri'i-'i:k wm.l'i-: cu- thi-; iii.ood* K. L. Li;\V. Mb. .AND I.. G. KOWXTREK. M.D. ii\'Ti^i"J"! Ml^■.\-^\^•c.l.I^ In iinlcr llial tin- \ariini- luiutidii- ni tin- 1„m1v iiiav In,- prnpfrK pi.rfnrnicli-lul\ alkaliiK i-|nihhriiini ni the (.r-ani-m and tia-ixhy i,n,t^vt the Mood from Mgiiiti- caiit chani;r~ m h\ tlruL;en-ii .n i-niurniration. Surh processes are mcrca>cd jirochiction of ammonia, tlic e.vcrction ol' carbon dioxid b\ the lun.i,'-. the excretion oi" nonvolatile acids by the kidnevs. and linally, the hulVer action of ih, hi 1 ii-rlf.' l;y the term "biHIer acti,.n" of ;i mixture i- meant its ability to take ni. coiiMdcrable anionnl- ni acid or alkali when iIicm- arc adi'led to it. without api)recia!ile ,han,<,'e in hydroRcn-ioii concentration. 'Ihe bki.id i- such a btiirer mixture, ou m- iar<;ely to it< content nf carbonate> an.'. pho>phate-. and. to a le~~er ixteiil. it- protein. Much \, Iiiahle work ha- been done to determine ti.e r^le played ;iy each of the f.utor- CMnceriied in the maintenance of acid-base equil b- rinm. hut a jireci-e iiive-tigati.m- of the -butler \alne" oi t!ie blood has not been undertaken, owins.; to technical clifticultie-. The utdization of tile recently-described dialy-i-indicator method f(ir determinMii; varia- tion- in tlu' b\dro,-en-i,,n c..iicentrati..n ,,f the bl 1 ha- made possible a (Hiantitati\e -tndy of it- hiilVer \alue. I'rom llie .\K.lic..l ( Iniie .1 ilu .lohns lk.pkin> Hosijitul ■PH I- -he ...n^n,.nl^ .,.,v|m.,I ..m,,!,,! „ „- l,.v,|r,,u,„-,.,n CDeentrafon, 1. l-..r a deiai nl ,li..„-si-.. .^f ihe mechanism- involved u. the ma-ntenciice .. ac,.l-l,a-e_e,|,i.l,l.,,u,,, ,„ ,1„ |„„|,. .,,, 1 1,,,,!., -,.„. I., j.. |.;,„|,„. .|. ].|nv ,| 1 'I I'', vni. 3.1-4. -' I'nrn,;; il„- ouir-c ,., n,i- mu.Iv. a prrlnnin.ir, , ..mmunu-alinn ,„, •'The -Nalure ,,„.l I eteel,.,,, .,| l),.,!„tu \,„l,,.,..- |„ \ .,„ vKke, .S„||,„an ,„M . ullcr. apiH-are,! ,„ the IV.c N ,,„„,, ,;„., ,„„, ^,,„, ,„,- ^., ,,,. .,1^^ .^.^ ^^^^^• tl . . ial.s-,-.„.,l,cal..r nutli,,,! «a- Ih„,« utili.-e,! i,,r .lctenn,ni„K the hutter valm- •■1 111.; I.l,.,„l was aMn..,Mie.-.l «ith tlu- pr, -, nt.u.en ,,t our method h-lor,' the A-neiation ot .\meruan IMi.v sican-, M.,v I'M,- i .sec Tr. .\-„ A,,, P|,v. l''l.i. and ah'itract m .hmr. .\m. M,,| .\smi.. I'M,,. I^iv JU,J i ' " J I.ev.v. R. I.. Rowntrcc. I. (;. and Mam ,tt, W. MckTu, : .\ Simple Method for IMermtmni: \ ariat.o,,- ,„ ,|„. Hvdn..e„-h,n t ..iKeiitrali..,, ul the Wood, • The ,Ktcrn.im or plaMua. but it i, prelcraMc lo u^i' whole bloo.l. ^hu■c in iliis way con.htu.n- m the ho.ly arc ir.ci^t clo>clv aii|iroxiniatcfl. . , Two cnbic ..-ntintctfrs <,t Moo.l ar. flacd .n .ach ot >cvu, tct t.h > . u ;,llow..l to sta.nl tor liv.- or six .ninut.>, until a tlnn layer ot plaMna at 1r to as bf.n cUar..l of c.ll<. lutt.olvMs on the M,hs..,ucnt a.l.luion ot aoni atul alkal. tCr 'l, I, ■ c ,,r..v.n,.,l. The Moo.l in the hr^t tube is n.e.l lor a .letennnjatum o tl ,. T o eac-h of the nest three tubes „ a-l.le.l f,f,.eth-nor,nal hy.lrochlortc a il-dl c.e to the lirst. d.i c.e. to the seeond. an.l .1.3 c.cto the .Inr.l. Sun,- iarlv. increaMUK a.uonnts of t,ftieth-nor,naI so.liutn hy.lroM.l solutu.n a^-; •?'l; -' .,, the la-t three ttibes. rhe tubes are inverted once lor the imrpose ot niiMnL.. l-ach nortion of blond i, then s.parately dialy/.ed for six minutes aKaui^t -.; ex. ,; y . ^eent. sal. .dntion and the „H of the dialy^a.e determu.ed by addm. 5 ,lro,,' of an indieafr. ,,lunolM,l,,hone,.!uhalen,. the read>n« be.nu deteinuml ■.y comparing with a -erie, of -lanilard colors. XitnRToU^ exiierntR-nl^ were .■.•,rru-,l nut .- .Icmni.u- tin- nitluaue Ml \ari()u- factors ,m the rcsult>. 1 /•//.•.•/ ,./ Tnnrn-.ninr. The .li;ily-;ile at teinper:itures rimsm;.' Mvtn IS tn .V- C. niav 1.- nlr.uieal or may -hnu -lisl.t chaii.nes/ hut n alhin these- cxlren.cs. no e-e.il.al elianoe j. seen in the hulter vahie- ot enli.-r hknul or -erum. Tlic .leteriiliiialion- eat., ihefelore. he earr.e.l ,„U at ruo.n tenivefature. yvi^lmnl feoanl tor the -liirht v.-.r.at.ons .,, eiU'iiUiUerecl. _'. /.,•».///( of liiiu- hLipsi,,,, i'n-twc.-ii tiu- Withdnn.al o/ lUood ,:ii.l ,/,.■ Cn-yy'iiui Out of I >rt,-ywi„ations.-^[h^ hlo...l may l,e kei-t tor a^ Ion- as twenlv hmr ii..nr> xvith.ait ehans;e in the \A\ or hnlter vnhies. pnTvicHn- 11 i^ eulUvUd in hanl t^la- Uihe-- wliieli are hlUnl to the n.]., li'ditlv -toitcreih an.l inmie.hately \:lwv<\ on ice. ~ 3.' Lcn.ith .., limr Ihr Acid or Alk.iU is iu Coulact :cilh Blood or V.-nnii.^A ~evie> ..i exi.ernnent^ ua- earrie.l ..nt in uhi.h the time „, ,-,„,t.ui varicl iniin two to lliirty minute-. Within tlie-e hmit-. i.l.iuieal huller \ahie- were ohlained in all cases. 4. Loss oj (\irh.u, /»,-,u7./.-ni,Ni,,n-lN. the carhon .h..M.l teuM.H. m the hlood U nni.,,rtant. (onlml expennuni-. n-iii- the .lialvM- in.hcator iiu ih. ,1 uilh earlu.n .hoxnl at f,- n..nnal ten-....., an.l uith Mno.l lv..m unieh ...rh.H. .h-.M.l ha.l heen shaken .ml, ~h•'^^''^\ ma'ke,. ,,i,-,Vrenee-in,-ll It „ , .. ,.Mhle t. , , , .lleet the h!. „ „1 in Mteh a way that ,lu- 1,,.-.,1 ...rii.iii .It.iM'l i-tninmialaii.l lan'l) cii-laiit Ihisi-ace.mi ,,l„lu,l l.v with.lrawinu' hi ' -"1' :> -.^niii;e ,,r i.ii.et. hUin.t; the te.t mhe practicalh t., th,- t..p, ia..n,,.tlv ^Xnyyvuu^. av...chi.u minece--arv -hakin- an.l i.la.anL; nnnte.hateU ..ii ua , Ih.iih.ate .lelenmnatt. .n- . m ,1k- -ante -.itni.le. ..r ..n .htter.nt -i.eemien- ff..ni the -amr ni.liM.ln.il, yiekl e-.eiiliall\ i.lenti.'.il rc-ult.- ini'ler tlic-e .■.in.hlnni- 4rilvv. K..wmree an.l Marri.Mt. b c. cit.. i.ote X The t.m, ■ .i , xp..M.re to a hiKlie-r temiieratnre is ohvionsly a determininn facL.r. Ml 'HI I ii i..\ri,'i;»iii\ 111- i All rrsiill> ;iii' I x|irt<-icl in tirms nl cubic cciitimiiirs of liltiitli-iionii;il Inilroclilnric ncid nr Micliiiin liydroxiil per 2 c.o. n( lilodd. Tlio follinviiin lirins .'ii iwiil : 1. lUiihr for .Itid .'i- . //',■, ;/i.--'riii-c ri|iri-ciit tin- uininiiil^ ul ;ici(l .ir a'kali ttliicli can In- adiKd to lilo. nl or siruni witliuiit rliaiiKc in the pi I o|' tlic dialyviti-.' Till- sum of the butfcr fur acid and that for alkali yields the Icltil I'liftrr. 2. h'lsrrvi- Buffer fnr .Uid nr .llknli. — These represent the amounts of aciu i-r alkali which can be added to blood or strum without causing a change in the |)H of the dialysate beyond the limits of normal. The sum of the two yields tlie lt>tal rcsvrrc buffer. Tlie reserve buffer, therefore, represents the simple bulTer value /•Ins the atiiount of aeid or alkali taken care of by the blood without ebanije in riactiun beyond the limits of normal pH values. I'rom a clinical standpoint it is the simple bnlTer valm s for acid and alkali which an ..f tlie t;r< alist sii;iiiticance. \.\\I.^SF-.S OK Cl.l.Ml.M. KIlSfl.TS I lit- wurk is liastil on a sttldy ni sj\ty-li\e cases, iiivulviiii; coiisirl- cralily niiire than 100 hiit'tVr ilcti-riniiiatidiis. Tlie n siili, ni;iv !,i'st lie |iri>sinliil l.\ .li\i(lii)<; tin- eases into I'mii- gnniiis, I. .\i'nii,il I udiiiilnals i 7i^\-iit\-l'oin- Casrs \.' — Determinations were made aw Imlli lilnnil- .iMil scrum, the resuli.s a]iiieariii<; in Tables 1 and 2. It is imu wnrtliy thai llie lime ela]isiiij; hetvvceli the previous me;d and the withdrawal ni hliind inr rNamiiialinii m.ide im essential ililTereliee in ihe hnlTer valtte-.. ((M lUodd. .\nnnal hlnuil lakes n] ,-,r. nf ,ioid or alkali wiiluiut ehanj;e in ].! I. Ii. iherefore, has .i Iml'ler fi,r a. id ,ind alkali of at least n.l.ihiitlyh it iiia\ ha\e a htttl'er nl" I l.i in ( 1.4. Ihe a\ i-raffe htllTer. hotll tnr aeid and .illv.ih i- d IS IIk inl.il linlVer r.niyes fiMin Hi i,, (1.7. \\itli a l;iii11|i .i\ erai^e nl i).M\. llu re-erve IjtitVer' Inr hnlh .leid ,uid alkali v.irii- trniii (i| to 114, llu' L:i"nii|i .a\ei-,aye t'nr the .■leid lieiiiL: d.i". llial fnr llu- .dl-ali n i| I'he tnl.d n-er\<- ImlTrr • .irie- I'rniii Ii4 in 1)7. ilu- ^r, ,M]i .aver.ai^e hellli; II..^S. ( /' ) .S'lTiu)).'"— .Xnniial -enilli .il\\a\- Lakes II I e.e. nl .aeid willimit chaiifjc in pi I. It ni,i\ h.ixe a luiticr fnr .i.id tr.ici. Xo bmir iii.li\idaaN are included in the scries. S, llu- blood was collected m tubes eoiii.iiiiiny iii^i -iilliciml > ai in -iiau -free s-diiiiii ci\,date to prevent clottinj;. ''. Ihe reserve values ilirnuKhout are not absolute, since in iii.iii\ instances IV.> c.c of acid and alkali failed to carry the pH beyond noriii.il liniiN. 10. The values for oxalated jdasma are essentially the same as (host- i',>r serum. ThrouKhont tlic later studies oidy whole blood was utilised, for the lollowiiif,' reasons: 1. In the body it -s with the buft'er of tlu Iilond .i. ,, whole with which we are eoiicerued. 2. Less blood suffices. .1. t'entrifnuali/iiilnn. together with the residtaiU loss of carlion dioxid. is avojilnl. :^ s? > j3 i^ i; jD r X i: « « '• 1- X X - ~; "T ''^ ' • - X I- "r '■: =• ^ •- '" I + « ,; 1- I- i- I- '- '- •' 1- t- I- I- i- I- I- < ^l'^ ,- I. I- I- K I- -, "- i- 1- I- ill- ' all (_ I- I- J ^ -^ » ). t- I- I- i' «• 1 + ' « u^ c o I- I,; I- I- t- I- t- I- I- i~ t'. 1.^ I- M r M '-^ VI V^ - t- i- I- a I ,^ I- t- I- nxcrayc i- Oil. It.s Imllrr idr alk.ili i-- \(.r\ \arj.ilili- , a chaMgt- ma) be ciKeur.itcrid on the adilitinii of troiii 0.05 to 0.3 c.c. of fiftieth-v" n .] sodium li\(lr(i.\iil : tlu' aviTa;,'i' i^ 0.07. The total ImfTci fur .-i niir. from (1.1 tii (i.i. IJK' sriiuji a\(Tat;e being H IX riif rt.'-er\c liutl'i.T idr aoid varii"- f rum II. i li j i ' 4, tin.- ,:;rin;ii avi-iagc luing 0,2. riu' rf~cr\r butYvi i'mi- alkali raiit;f> I'rum (( tu <)..i, the group .iverage hciiig IJ 1 ho total reserve butter \arii> from U 1 .^ to 0.6. the average being U.33. T.\BLE 2. — SUMM.MIY OF TWE.STV-Fill R X(jKMAI. C.\.sks BIooil Serum I Buffer ; For nlkiili.... 11.2 • 0.4 I Total ( For aciil... Rf.s.rve l.iilTcr... ' For iilkall. i Total Kstrcnips Group AvcriiK'' FMrnnrs 0.2 • 0.4 0.:8 0.1 - 0.3 u.; • 0.4 0.18 - 0.3 1 .L' 0.7 0.36 0.1 - 0.3 0:2 ■ 0.4 0,27 0.1 ■ 0.4 0.; • 0.4 0.31 -0.3 0.4 ■ 0.7 0.58 0.13 ■ O.fl (^roiip 0.11 0.07 0.16 0.12 0.33 1 WBl.lC ,\ — MiSlII L.A.MjUS t"\>l> WIlll XhRM.M pH .XNP XuKMAI. Hi h-lk \ ALUhs ; Sl.MhLN LA>K.-5; TuLMV UhlhK.MINAllu.N'S Blood I'.iiiTcr.. f For acid { For nlkali I I Total Fi.r a.i.l H.s.rvf biifTtr ; For alliali I 1 Total Kxtrenifs 0.1 0.3 0.1 0.3 0.2 0.5 0.1 0.3 0.3 0.3 0.6 Group Average 0.13 0.17 OS 0.28 0.23 0.48 -Mthongii the li.it'il butler \alue or the total reserve value mav be g'^'at, the butter f^r either aeid or .ilkali nia\ be -mall: in other word?, the butter m:i\ be gre.it lor aeid and small for .dkali, or \ iee \er~a. Ihi- e.in be determineil only by aetuil ^tudy of the indi\iilual aeid and alkali butler \alue<. .•ind it is ob\ iou-ly not ^liowii b\- ,i ligure expressing the total Initter value. 2. Misi(-lliiiu','iis ( \:si-s :e/7/( \,inii,il p!l ,ind .W'niuil Ihttjcr i 'iiliiis. - — I'weiity determination- were made on sixteen eases, ineluding instaitees of diabetes mellitus. jiernicious anemia, mvcloid leukemia. t\|ihoid fiver, pregnaney, .-urgie.al ea-e- before ;ind after atie-thesia, exo]ihthalm'.: goiter and ehrotiie ne])britis i i'able .i). .- r s .- * r ' ■ "i .' 7. '-''■. -.•■. ■•_>'.■/- -"^ > S ^ 5 _ — a II ■4 tf S « ^ "i •• ^ '1 r ■-. •■. i3 ,: tl t^ t' t- I- i- '- t- '• '- I- I- I- I. I- I- I- I- «- i_ r- I- I- X i t- I- I- I- - « ^ ii -^ ?! tl V u! I- r- !• t •• T, I,; t< f: :3j;i H u = = a O i r C .6 ~ =. s ^' £ " c" c" — fe e 4.4 7 •.7 zZ <* *• t _ » L - . c t ;: i ^ ^ (-. e e = c >* ^ ^ r 1 = lr,S ^ i 3 T =^> a: riu- \,i',iK~ iililaiiml aTl- uniluniiK -liL;liil\ luwtr ilian tim-i uh^i r\t-ul'ur .111(1 i\-S(i\i- liiilTrr \ahii-~ for aiid. niarlvcdlv (liiiiini~!u(l \aUu'» loi" alkali. aii(l tin v. iLv,. |M\\irc(l v.aliu-^ lioth l(ir tot.al and iclal ic-i-r\v ImlVcr-. ScMTal |i(jiii!- i>i iiiU-ii-l an- (.■\idinl irciii .a < (iii~iilcr.ili(iii of tin? i;roup (if I'.iso It is -triking that .a dimiiii-li(-'(! luilYir for alkali i> far iniii\ 1(1111111(111 tli.iii iliai for acid in (.'asc^ wliicli dn iKit >li()\\ a /)•«.' .icidd^i-. lint ill \\liii,'li tluTi i^ ;i IvikU-iu'v tow.iril aridn-i^. .'i- i\"i(lcii(.-i'(l ill iii.iin iii-t.iiui.- li\ .1 liiwirini^ nf llu- ttn^idii nf tin- ahidl.ir carhoii r\i'.l 1 5 ( \>l.~ WJUl XuKMAL rli AMI |)|MIM>llMi Hi Mil! \' \i rK.!^ ; SixiKKN Cases.- Twi mv-I-ivi Dkii.kmin'\tiii\> BInii. t - 5 = HulTcr Kl•^.■r\(■ hi.i'.r. I F.ir aii.l i .; F(ir :ilk:ih I 1 Tiitiil I For mi. I I ! For alkMl I Tcliil. KxtriMiH'i* Grodi' .XviT.iK '1.3 O.l' 11 ■ 0.3 0.1)11 11 • (I.e. O.X'i (1.211 1...1 U.l* tt.:l - (i.ii ll.Jl P = s % « 1. r iliu.\id ( ( .i~<.'s 1, 2, 4, 5. 10 and Id i I In iliniinislu'd luitUr l(ir alkali olisfrvid III two i-asi's of nonn.d pu ljilhii \ i Ca^c^ 14 and 15i is in accord.iiii 1 Willi lli( .iliiiii-l iiin-t.iiit tiiidiiiL; nl a Idwiicd alveolar carbon didNid hii-imi ilntins,' tlic nimitli- (it j,;(.'~iation.'' Case 4 ( iiHT. iirii' cliKirid ]iiii-iiiiiiii: i ^Ikiws at variolic ~l.ii;t~ diiiiii!; Ilif clinical C(iiir>c ^cu r.il pli.i^c- nl liiilicr Ic^- \t lii-i. .ifu i \\\v d.ivj of amiria. tlnrc w.i- lii>~ of luillcr fi ii .icid ; w iili -li^lit i liiiii .4 iiiiproM'- iiicnt and ilic k i -t.ilili^liincnl -ii iiiiii.nx -i i iciinii. InilK r tor ncit! ri turned, w In i ca- tiiat fdi .dk.ili w.i^ iliiniiii-luil A fui iiilcii-i\c alkali tlicra]i\'. .111 alk.ilioi- \\a- c-talili~licil llidUi;li the aKcular carlmn (li(i\i(l \\a> .still siiiiu'wliat io\V('rc(l : ilic luitfi r v.iliic- were normal. October 6, a slitjlit ^cl back dicnrrcd. with In--- ni biiiur im .dk.di It \\.i- I'mi.;- nosticatcil at tliis time from llu liiiffcr (litcrniinatioiis that llie alveolar carbon dioxid tension, wliiih iwd d.iv- ]ire\idii>lv li,id been nonn.d. 11. I.fini.= "*"•- ^' i - r i: ^ r; 'J = ■^ p ,E , t — ^ "" :£ — " 5 T ^ ^—i — — = t t-r — — "■ l§!'.riil| ^ - - r. i'- '- ^ ~^-i - * . ||^-|;^^x ■- ^ i£"r J 5Z— ■ - ■ - ¥ = ^ -iirl.l'^'Z^'i =lii = If.l^i'tl^fM = |ix ^ > - - - *" -, ,_ . ■? a i -: ~ ". I- I- r» s 1= , ■• I + -r , ^ r- « i» ';4 - =-i:r V ^ ■= ^ ^.r /.| i E = = cf = ^,J[; =;^ "? U7 _; = ^^^■=I:t:l=.-r"i-'l^= = . "i ' H — "..£. >• ilrll^H^llhll ^'■^ T ="1 '''■'_: k" £" < ' < ~ ';^ ' C « 'j ^ I- I- I - •rf -i '=3 t^ I- I-. ':1 a — — — 11 « n C 11^ ^1 111 • - ".r Iv: |3 5 « 2 ' 1(» u.mM 1.C tniHKl to l.c- af,'am InwcnM. which. iiuUr.l. i.rove.l to be true. Finally, .lunnu .nnval.^.v.u , . hmh pll an.l Imtl.r value- became norni.-il,. ..... IIk- In-s of Imller t.ir alkali .,b-erve,l iirtuu m^t.iucc- ..t tehnle t\,,hni,l aa^e^ S an.l "i i~ m aec.ml with the tendency toward r.n a'lU,-,l,,.i. which we h.ave ob^Tved in ^e^er,al c.-,m . of ihi- disease. -,M;I|- 7 \( I-; NiNK Casks: Tuim\-I-"1k |)i ii rminatim.n- Blon'1 Aci.r ' AlKMi ;|^" l^^ZZ^^ Av.Ti.urs~ K.ttroii.- .Awragos K.-(lreinc-« Average' Kntlri' grcmp i'.' vnfe^. 2i j, ,|^- ^ -(i.l u.lT lietiTuiiuatloDsi... ni.riiKT ftni!.' TuTAl. lilFRR VaUIS FOR IHi VaRIhIS C'ASb C.R'.M-. I'.XrRh>SHl A^ l.RHfP .\VI.R \CI.S llliif"! ~" AciiT Mk:i'' ■'"'■" Niirliial imlivi.liKil!- MiM.lliin.M.u* luw- Kill, mirnial pll. flmwing imr ^ j. |,.,„ liinl bilrtT viilnc'» <„.■■. nitl. iMTiiiul |ill .Lowing itiniinl'tiiM t.MfT.T ^ ^^ j^^^^j „ ._,. viiliir* ■'"■'••'■ .,„MK.n.„...i "'O »'» "■■"' 4 /.„/,,,.> , lal.K- i> am! 7.) I- n.ni llir lahh- it i- .v i.lent th.at ca»e* of aeido>i> have 1. - bulter fur both acl ,n,.| ,,lkali dnnno il,e Mane nf uncomi.en«:aeis (increased id! of the blood I than .lurini; lb.- >tai.'e in which the tension of alveolar carbon dioxul is ,li,nini>iied. b.it the id! of the blood 1^ norm d i M.iye of co.npen>ation ). lk->l,ite Ihe return to normal of ,,ll and bulter value-, the cbmcal evi- dences of acidosis may i.ersist (Cases 4 and 8). 1 M-l KIMlNtM, <.lS>nil:i< MInNs Ina-much :.- tlu bull r value ..f blood i- fairly constant in health, and deereased in .acidosis, the question ubxiously arises as to wliethtr l.ufiVr can b, sn,,,,lif,l The possibility of accomrlisbiuj- tins with 1^ n ,,!,„.pl,au- nuMu,v~ ua^ >,,nM,kv.,l I lu ImlUr ^alnc. ... ,.h,p.l.a,r Inixtim.s ,.\a IIP' ' Kll I'm., „i van,.,,- ~;m,.,ih~ a.ul Inalro'^cu- i„n oonce.uratiun^. u.n .iun-,.,,-. ,kt.-rnn,K ,1, Uk- rr^ult^ a,,,.arn,g u! l.-,,,>n Ihi^ ~u,.U f.nv MiKix-mi--; la> W an- ex id.-nl : lu-l. ll.c huUvV ,alu. ..f M ! ,^.,vaur,hautha, nl . „ n.-t-vnlar , In 'i'l-U' ""^ tUR- an.l ai.pn.xin.atcK tha.l nt ' .-, niuKvular nuMiuv^ ; -com.l. the LulU-r ^ahu• i^ '^tvaur at nrturalilv tlian ni .m.iv alkahno nnNUuv>: lliir.l the .liah-al.- c'xlnl.il l.atV.T value- eo,„i.aral.k- tn tlf-o ..btaiiict !,v a.Mi.iii tlu- i.uli.atnr anartlv tn tlu- nri.uinal nuMiirr-, In.t at a 1 \L;I,I- •>. \UnfM Vami- o^r.u,SfiiMi_MiMrKK:- , \ v Ul'i i. - KH VO,) , :;., Mol«..l,,r UnJSoWtuUn 1 J^lnlwuhn "in.l^^Tlyz.M"" I.inly^ai.. lndU.bV"l rmllalyz."! Iil..lN>ai. I'll 7 ■•.'• 7.1 111 llll.l 7 4'i 7.3.-1 :.i 7.5 -I1.-2 ilCiit 7.4 7.25 715 7.4." ■ 0.3 iici.i 7.3 7. IS 7.15 7.1 -l>,l iiclct -.•.• 7.1 7 1 -11.1 iilkoll 7 •' - r^ 7.3 7.5 -O-J alkiill 7.7-. 7.11'i ".:!5 '•■- -03iilkiiM 7.- 7.7-'. 7.» T.?» 'a.4itlkiili « II 7.S "■*' iixE-rirTKiM H \i..w M< \I.I K KM.INC- OS rMH.M.Y/KIl MIXTfRKS I'll . ..lu.ia ■ (1.2 ml.l 11.3 ai'iil O.l :llk!lll ii.-> niknii II :: iilkiitl 7.05 7.M li.'.Ci 7 »5 7.U5 7.1 7.15 7.15 7.75 7.3 7.r 7.35 (i.O 7.4 8.1 ,„„,nniih n„..a .,. ,.1 !.m ! . ..".1. Imall-. . Hm tmii, . ..nrmir.itr,! the mix- ture emi.lu>eil. Ih, U-- nuiU.il i- the .h-. re|u,u . helueel. lite UU.ha- l\zere lel.iluelv tu.nlnMe '- h\ uilr.a venous ,1, .ill,] iMiii ,1 human case \2. Sw. aUd. (iri'.iiual.l. 1 . .lour, riianii.unl. ami l-.x) ,1 |-.\ii.r llurai. I'M.i, vii. .v. < * a I s if - — t- i- 13 ■■ =v !* !* ■= 2 VJ S S S ? S W £ = ^ T? ?! ? ?. '« z i < o 5 « I o u I 5 i a o - i • I :,=: .J a 3 — . •""< = ■ p 'J ■-; S S «i S .^ = £ S S S S S = s 14 2. 1 111- iiiii-i'iiiiii Ml' -(i.lmiii iiliii-|ili.it< I .\;i I i I 'I >, I iSiii) ;a'. nf i ' - miik\'iil;ir sdhitiiiii npfc-nuini,' _'S ? ^iii. ..f llu- -alt i iiilci an animal III 11 ki,'. dill mil pniiloro an alUalo-i or innra-i- liu' Imltcr values. \vliciva> \\w inii-clinn nt 7r*^ ex <<{ a 'i,-, nmiiiular nnxtnn- ni' ili-Mi- iliiini |ihii-i'iialc i .\a I 1 1 'i i, i ami a.iil ]iiila--iuni iilm-iilialc i Kl I l'< ),) at I'll ~.n inlii a ilni; wciyliini.' (i. no ('hanm' in llu.' iliniial cdmlitidn ■ if the 1 alii'iu. wild died l\\(i himrs lali-r. Hull I r I i:liiis ill l\.vpcrinuiitiil .Lnh'sis and Alk^ilosis. — I Tahlcs jil.ind 111 It i---i.in irum l\|i( rinunl 1 tliat in tin aoidii-is jmiduci'd liv tlR' iiilra\cndii- inji^'liim nl' an indri.;anii.' acid i liyilnu'lilnrir a<.-i(l ) iIk' hiifUT \aliU'- ma\ ii'inain iiraclicallv imnnal, alllidiiiih thcfi' i- a di'iidi'd Iduci'iny 111' llu- ,d\(iil,ir .-avlnin didxid and .i inaikcd iiuna-i. Ill thr jil I dl'llu- liliidd. 1 hi- i^ ill accdril willi wlial i- -niiK-liinc-- I'dimd Ml llu.' aciild-i- 111 ihrniiu- iu']ihrili- with uremia and in llial nl (lialii.-ti-- . l.iIiU- 11. ia-c- 1 Id ''. imlu--i\i' I. .\l'u-r iiiji'i-lidii (it alk:ili tu dvev- I'diiic llu' aiidd-i-, lluii- i- a lran>ii-iil diininutidii in tlu' hufft-r tor alUali. l'(itlii\vi-d li\ a )iri mpl r(-turii Id mirinal \aliK-- a-- llu- jdl nt' tlu- Mddli 1- IdUelCil. In i-\|i(.rinK-iilal alkald-i- ihc liin'lcr I'nr aiid i- lir-t dimini-lu-d. llu- ahcdiar r.irlidii dinxi.l ri-e- tn iiiin>i;all> lii.i;li liyiiro -fo." mm, in llii-- animal. Al'li-r iniotidii df -utticictil hxdrdililnrii' aciil Id dvii- ciinu.- the .dkald-i- and iirndiui .a iniM aii(ldS!< with idWiTi'd alvcdlar ..irlidii didXid Uii-idii. tin.' liiiliir t-ir Imih ai'id and all-ali i- ln-M-rcd In llu- in-laiuo nl nu-ri'iii ic chldrid |)di>diiiii^ i( a-o 4. lahk- 4i. in which llu- ]iatimt n.'cci\i.(! lari;c ild-c- of -ddiniii liii-arlmiiatc Imlli li\ iniiuth and iiitra\i'ndn-l\ . a -iniilar idiidilidii nl alkaln-i-- \\ a- ]irddui id. tllciUjLlh lure tile lilltTer \.iliu- riiiianud luuiiial .it llii- ~:.iL;e nl llu- di-- la-e. and the ahenlar e.iiliiin duiMil Ini-Uin w.i- -lill lnw ,i,i.(l mm nl I \ -imiiK- niitlidd i- di-irilud iHi 'IrU rminiiii,' (|iianlitati\ el\ the liiiiur \,iUu III llu 111 1, li e.in-i-i- m .iddini; iiuTeasini^ amdUiil- ni lil'lielli-ndi'm.d li\ di i h lilnrii- aeid and li ft ielh iiiinn.d -ndniin li\drd\iii -dlutiiiii Id ri|!i,l i|ii,i;nitie- III' liliiiiil .Mill iili-i-r\ iiil; the rr-iiltin;' ■.hansel- m Indnimn um > i nu i nlr.iluiii li\ iiuaii- nt the diaU-i~ iiidii'aliir nuthdd 15 2. I hr ivMil'- ,ii-.- cN^iv- ,M in u-nii- "i 'iiln.' ■ riiliiiulrr- ui lil'lirlli ii.Tiiial .1. I'l "T :ills;ili I'cr 2 '-X- "i 1i1(iim1. .;. Ihr ImH.r \aUu'> ni hlou.l fur acul .iiid .ilkali yu-1.1 valiuil.lc ininniulK.n n-ni a rliniral Maiidpoint. 'I'lio rc-cvM- and lulal l.iiU. r- mav al-o l.r calmlalr.l lr..iii iIk- rt-iili- of tlic .Iflcrniinalions. 4. riu iiiininial \aUu~ for norinal Monil liavo liocii (K-tcriiiiiud ; ,.m-.i.l>-ral.l\ lar-cr \aUlt> may be ciu-oumi-rol, l"or a -roiti) of mi- ^x'llanrnii. ,'a.i-, with iioniial i.ll, tlu' avcrayi- Imtlcr vahu- wi-ru -.im- wliai lowiT. ilioush williiii iioriiial liniil-^. 3. Ill .cnaiii ca>i- witli normal ]A\ of tlic l)luod, but >b()\viiis a liiHkiu-v toward llu- dovclopmnit ..f an an.losis las evidcii.-cf buflVr for alkali wa, far more strikin- an.l inqui'iil than for arid, and ua^ ofti'ii a-.R-iated with lowcroi alveolar rarboii ,li,)xid trii>ioii. \~ a iv-ult ol therapy, o-i.eeiallv the u-e of alkali, llie bulVer \alue> in Miine iiiManees returned to normal. (.. In .1 >erie- of ..i^e^ ..f aeido-i~ the .average buffer value- were fwniid lo be iiiarkedlx dinmii-hed, partieularly durin- the .e\er. in the pre-enee of a true aeido-is. Coincident with eliiii.-.d imiivovenieiit follnuin-: treatment, partienlarly inten-ive alkali llierai'V. both jdj ;iiid btUler x.due- a|.i.r..Nini.ite.l or beeame nor- mal in -f\er:il ease-. 7. ,t wa- nut lM,-ible to -ui^plv bnliVr lo tlie bkn.d bv the injeeti,. i iif iilid-idiate mixtures. S. l',y till' intraven.ui- injeetioii ol tbir.l ii. .riiial bvdroehlone aeid and 4 i.'er eeiil. -.Mdiuni biearlnniale -olntiun into d-u-. e,,nditions ot aeido-i- and alkalo-,- x\efe produeed vvbieb ueie nie, ,ii-lantlv aeeom- jiailied bv eh;in,m- in tbe bnlVer \alne- of the blood, 9 riie deleiniinatioii of tbe biilfer \:dne of the blood. e-|)eei;illy in cases 111 uhi.l, ,ni .aei.lo.,- i- Mi-peeied m- |,ie>em. vields information of some