The Circulating Blood Volume in Diabetic Acidosis.

The clinical evidences of dehydration which are present during severe acidosis in diabetes mellitus raises the question as to whether alterations may occur in the volume of the circulating blood. Such alterations, if present, would influence the apparent concentration of various blood constituents in acidosis and would be of pathological significance in several particulars. It seems likely that a marked reduction in blood volume, particularly plasma volume, would have some bearing, mechanically, on the occurrence of heart failure. It may also explain in part the occurrence, frequently observed, of renal irritation and insufficiency in diabetic coma. The terminal anuria, usually ascribed to lowering of the blood pressure, may also in part be due to a similar cause. Studies of the concentration of the plasma proteins, however, or of other blood constituents (1), have not certainly demonstrated alterations in the blood concentration, and we are not aware of previous attempts to measure the actual blood volume in this condition. We have therefore undertaken a study of the circulating blood volume in diabetic acidosis and the effect of treatment upon the blood volume. The technique for the determination of blood volume described in a previous communication is especially suitable for such a study and has been used here (2). It has appeared to us that the character of the cases studied in an investigation such as this is of great importance and that in order to ascertain as far as possible the effects of diabetic acidosis alone, other possible complicating factors must be rigidly excluded. Circulatory disorders, arteriosclerosis, renal disease, inflammation, and fever may have important effects. The number of cases presented therefore is