Notes

WATER AND ELECTROLYTE STUDIES IN CHOLERA *
By RAYMOND H. WATTEN,t FRANCIS M. MORGAN,t YACHAI NA SONGKHLA,t. BUNAM VANIKIATIt AND ROBERT A. PHILLIPSt
(From the United States Naval Medical Research Unit No. 2 (NA4MRU-2), Taipei, Taiewan (Formosa), and the Department of Medicine, Chutlalongkornt Uniiversity School of Medicine, Bangkok, Thailantd)
(Submitted for publication March 17, 1959; accepted June 19, 1959)
Rationaltreatmentofcholeracannotbepro- videdwithoutpreciseknowledgeofthewaterand electrolytelosseswhichoccurinthisdisease; suchinformationisnotavailableintheliterature. Studiespriorto1900usuallyreportedelectrolyte concentrationsinwholeblood,notinplasma,and sodiumandchloridewerefrequentlyreportedas NaCl. Since1900therehavebeenmanyreports ofelectrolyteconcentrationsinplasmaorfecal excretabutonlyonepreliminaryreport(1)re-
pitalduringJuneandJuly,1958.Apositivecultureof VibriocommSaaasobtainedon17ofthesepatientsonce ormoreoften.Asthe1958epidemicwasconfinedprin- cipally to Bangkok and nearby suburbs, patients were abletoreachwell-staffedhospitalssooI aftertheonset oftheirsymptoms. Themajorityofpatientswere re- ceivedinfaircondition;however,severalpatientswere inmoderateshockwithsystolicbloodpressuresunder 100 mm. Hg. There was one death: an 83 year old woman with electrocardiographic evidence of cardiac diseasediedthreedaysafteradmission.
Avenousbloodsamplewasobtainedonadmission: thereafterblood,urine,andfeceswerecollectedatin- tient. However, this report suffers, as do al tervalsofonetofourhoursduringthefirst24hours,then lessfrequentlyuntilthediarrheaceased. Convalescent blood samples were taken prior to discharge. Five pa- tients left against advice soon after their diarrhea
latesfecallossestoplasmalevelsinthesamepa-
othersoncholera,fromthefactthatoralintake was not restricted and it is not certain to what extent fecal electrolytes had been diluted with oralfluids.
The 1958 cholera epidemic in Bangkok, Thai- land, provided the opportunity to perform quan- titative,volumetricstudiesofwaterandelectro- lytesinplasma,fecesandurineforthefirst24 hours after admission in patients suffering from cholera.Duringthisperiodoralfoodandfluids werewithheldandthedehydrationandacidosis were treated by intravenous fluids. The effect ofwaterandsodiumloadingonelectrolyteex- change was also observed and whole blood and plasmaanalyseswererepeatedoneachpatientin convalescence.
ceased; some of these "convalescent" values may not accurately represent their normal blood composition.
Care was taken to avoid spilage of feces. A large bore rectal tube was used for the first 24 hours in ad- ditiontoacholerabedinwhichthepatients'buttocks wereplacedoveranopeninginthebedframeand excreta collected in five gallon containers. Retention catheters were placed in the bladder for the first 24 hourstofacilitateurinecollection. Urineandfeces weremeasuredingraduatedcylinderstothenearest5 ml. Aliquots of fecal material were filtered through glasswoolandaSeitzfilter.Bloodsampleswerehepari- nized and the plasma separated immediately after a sample for duplicate hematocrits and whole blood spe- cificgravitieshadbeenobtained. Fecalspecimensand blood for plasma CO2 content were collected under oil and analyzed within 20 minutes.