Observations on the Chloride Metabolism in Congenital Pyloric Stenosis.

A fall in the chloriine content of the blood in cases of high intestiiial obstruction is a well-recognized biochemical finding. The opinion is genierally held that the diminution in the level of the blood chlorine is due primarily to the loss of chlorine by the vomitus. Accompanying this decrease in chlorine there is ani increase in the CO2 content, resulting in a non-gaseouis alkalosis ww ith a diminution in the respiratory exchange. This increase in CO2 Mould appear to be the result of the body's effort to maintain the ionic concentration of the blood at the normal level, and simultaneously, to compensate the deficienicy in the acid radicle. Very strong experimental proof has been brought forward by Gamblel and others in favour of the truth of this hypothesis. In a previous communication2 we have shown that the blood chlorine tends to be low in congenital pyloric stenosis, the diminution being roughly related to the severity of the vomiting. But we have seen cases in which there was present a typical picture of alkalosis, as indicated by the raised blood CO2 content and the depressed breathing, either duiring a period in which no vomiiitinig occurred or, as in one instance, when there u-as a complete absenlce of vomiting. In Table 1 examples are given in which the depressed breathing was a feature despite the comparatively normal valuie for the blood chlorine. lIncidenitally, it shows that there is iiot necessarily a correlation betweeni the