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Lectures ON THESYMPATHETICINNERVATION OFSTRIATED MUSCLE John I. Hunter1925 год

Lectures ON THE SYMPATHETIC INNERVATION OF STRIATED MUSCLE
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Аннотация: BRiTim blood t hen resuilts in an urgent attempt to prevent further accumulations of CO2 in the tissues.This hyperpnoea is one of the clinical syimiptoms of aoidosis.(B) The acids whicih gain access to the blood are intermediate products in fat katabolism.(C) The imperfect combustion of fats is associated with, and is perhaps due to the absence, or diminution, of, that product of carbohydrate metabolism whlieh sets alight this combustion. (D) A primary deficiency in carbohydrates is therefore an essential preliminary fault in cases of acidosis. (E) This deficiency may be due to an insufficient supply of carbohydrates to the body, such as occurs in cases of, say, pyloric obstruction with copious vomiting, or to an imperfect metabolism of carboliydrates of which there is no lack.The anaesthetic chloro- form probably interferes with carbohydrate metabolism by its direct action upon the liver cell.( F) In cases of carbohydrate deprivation the deficiency may be at once made good by the administration of glucose.This cannot be given in adequate quantities by the mouth to patients afflicted with acidosis, on account of the vomiting which is so persistent.If administered by the rectum its absorption, when considered in relation to the urgency of the patient's need, may appear slow.If it is given subcutaneously the quantity taken up is small, owing to the enfeebled systemic and lymphatic circulations.When administered intravenously there is no reasonable limit set to the amount which can be given.Either a 5 or a 10 per cent.solution may be irijected; an isotonic solution contains 4.15 per cent. of glucose.Matas of New Orleans, a surgeon to whom our debt of gratitude is very heavy, was the first to suggest (in 1911) that glucose might be given by continuous instillation.He has recently3 described an apparatus which renders easy the " continuous drip intravenous administration of a glucose solution maintained at an equable temperature.About 8 pints may be introduced in the period of twenty-four hours; I have once introduced as much as 18 pints.A reaction is seen not infrequently-the patient shivers and then sweats, a miniature rigor occurring; no anxiety need be felt on this account.The cause of the reaction is doubtful; it may perhaps be the too rapid administration of the fluid.(G) The mere accumulation of glucose within the blood is not, lhowever, all that is necessary.The glucose must be utilized by the tissues.We owe to Thalhimer of Milwaukee4 the supremely important suggestion that this may be done by the injection of insulin.My experience of the method is small, but it is enough to say that a new remedy of considerable importance is now at our dis- posal.Insulin must not be injected until there is a good store of
Год издания: 1925
Авторы: John I. Hunter
Издательство: BMJ
Источник: BMJ
Другие ссылки: BMJ (HTML)
Europe PMC (PubMed Central) (PDF)
Europe PMC (PubMed Central) (HTML)
PubMed Central (HTML)
PubMed (HTML)