A comparison of the value of crystalloid solutions, whole blood and blood plasma in the treatment of dehydration in infancy.

In an earlier communication (Aldridge, 1941) attention was drawn to the fact that in addition to water loss in dehydration in infancy, there is loss of electrolytes which may alter the acid base balance of the blood, and that oliguria may play a part in producing the condition. Treatment of dehydration is, therefore, designed to deal with these three factors: to this end fluid in excess of normal requirements (at least 2! ounces per pound of body weight per day) must be administered, and if, as is usually the case, the patient does not take sufficient fluid by mouth, it must be given parenterally. The common methods of administering fluid parenterally are the subcutaneous, intraperitoneal and intravenous routes. At the Birmingham Children's Hospital the subcutaneous and intravenous routes are used almost exclusively. The fluids used are normal (0-9 per cent.) saline solution and 5 to 10 per cent. solutions of glucose in sterile triply distilled water or in normal saline. Moderate degrees of dehydration are treated by giving normal saline as a continuous drip subcutaneously into the thigh, using between 100 and 150 c.c. (10 to 15 c.c. per pound of body weight). In children showing severe dehydration fluid, usually 5 or 10 per cent. glucose in saline, is given intravenously either in single doses of from 10 to 15 c.c. per pound of body weight or by continuous drip which is kept running for twenty-four, forty-eight or even seventy-two hours, depending on the condition of the patient. Although it has been the custom to give citrated blood to patients who do not respond to such treatment, the desirability of so doing is discussed in detail later in the paper.