STUDIES OF SHOCK PRODUCED BY MUSCLE TRAUMA: III. THE EFFECT OF SERUM, ISINGLASS, GLUCOSE, CERTAIN SALTS, AND ADRENAL CORTICAL HORMONES ON SURVIVAL

Abstract

The effect of the administration of dog serum, isinglass, and of glucose, certain salts, adrenal cortical hormones, and of water on dogs subject to severe muscle trauma has been investigated. Isinglass was found to be as efficient an agent as dog serum in restoring the blood pressure and in prolonging life. The effectiveness of transfusion was not increased by giving amounts in excess of 45% of the calculated blood volume nor by prolonging the transfusion from one-half to three and a half hours. Intravenous injection of hypertonic saline before transfusion with a blood substitute raised the blood pressure but did not lengthen survival, and pulmonary oedema was more frequently observed in dogs so treated. The addition of glucose to the blood substitute produced neither permanent benefit nor ill effect. Some of the animals died despite high blood sugar levels resulting from the infusion of glucose. The addition of sodium bicarbonate and calcium gluconate to the transfusion fluid, singly or in combination, did not affect the blood pressure or survival. The ingestion of large quantities of water by mouth after transfusion increased the average duration of life and improved the chance of indefinite survival. The most important single criterion as to whether a traumatized dog would survive indefinitely following transfusion was the level of blood pressure at the time transfusion was given. Indefinite survival of dogs transfused after the blood pressure had fallen below 70% of the initial pressure was exceptional. Those treated before the pressure had fallen so low had an even chance of survival. The administration of adrenal cortical hormones in relatively large amounts had no apparent effect in prolonging life in dogs transfused after the blood pressure had fallen to less than 60% of the initial level. Of eight dogs transfused when the blood pressure was between 60 and 70% of the initial pressure and then treated with carbohydrate-active preparations of the adrenal cortex, four survived indefinitely. None of the control animals with the same blood pressure range survived when treated by transfusion alone. The finding that dogs subject to muscle trauma are clinically sicker and less likely to survive at blood pressure levels successfully endured by bled dogs is discussed. The importance of the impaired blood flow in splanchnic viscera is considered in relation to metabolic changes. Changes in the urine of these dogs are described, and it is concluded that suppression of renal excretory function did not contribute significantly to death following trauma. Impairment of the renal pressor mechanism is considered to be a possible cause of the cardiovascular failure, probably in conjunction with impaired function of the adrenal cortex and toxic substances released from damaged tissues.