The effectiveness of intravenous hypertonic sucrose and adrenalin in the treatment of status asthmaticus

Abstract

T HE patient in status asthmaticus is an acute medical emergency for which there is no satisfactory method of treatment. A measure which will relieve the grave respiratory distress immediately, even though temporarily, may be lifesaving. The bronchi and bronchioles, in bronchial asthma, are partially obstructed by exudate, by muscular contraction, and by swelling of the mucosa. This partial obstruction must be more marked in status asthmaticus. The difference in degree of obstruction is probably due to an increase in the exudate and in the swelling of the mucosa. Naturally, such reasoning is purely theoretical. Therapy, nevertheless, should be directed toward the alleviation of the obstruction. It is necessary for the patient to relieve himself of the exudate by coughing. Adrenalin, because of its constrictive effect on the blood vessels and its dilating effect on the smooth musculature of the bronchial tree, gives relief in the ordinary attack of asthma. Adrenalin is often inefficient in status asthmaticus and the patient, therefore, is generally considered to be adrenalin-fast. However, it is more logical to believe that the partial bronchial and bronchiolar obstruction has developed to such a degree that adrenalin alone is insufficient. The mucosal swelling should be lessened by increasing the osmotic pressure in the circulating blood with some hypertonic solution, thereby drawing the excess fluid from these tissues into the blood stream. The effects of various hypertonic solutions on t,he cerebrospinal fluid pressure have been extensively studied. The observations on animals by Bullock, Gregersen, and Kinney1 a,nd on human beings by Masserman2 and Hahn and his associates,” indicate that the secondary rise in the cerebrospinal fluid pressure following the use of hypertonic glucose and saline solutions is avoided by using hypertonic sucrose solution. The osmotic effect of such substances as sodium chloride and glucose, which pass through the capillary wall with ease, is curtailed by diffusion. Sucrose remains in the blood a longer time after injection because its molecules are larger and less diffusible. Furthermore, it is not broken down to any significant extent or utilized as glucose, nor stored in the tissues as is sodium chloride (Bullock, Gregersen, and KinneyI).