SOME ASPECTS OF PRE–ECLAMPSIA AND ECLAMPSIA

phate to 600 or 1000 millilitres of N/4 sodium chloride solution with 6% glucose solution was given intravenously to most of these patients. For the small babies under ten pounds in weight the solution was used containing one gramme of potassium per litre, for the larger babies the solution containing two grammes to the litre. It is quite safe to administer these solutions up to a rate of 100 millilitres per pound of body weight lJer diem if necessary. Oral potassium therapy was also given as soon as the infant could take fiuid orally, usually in the form of potassium citrate, two to four grammes daily in divided doses according to the size of the infant. Intravenous therapy was usually discontinued in thirty·six to seventy-two hours, but the oral potassium therapy was continued until the child was taking full caloric requirements daily in the form of milk. Prevention of potassium deficiency will occur only when the disordered physiology of entero-colitis is understood by the clinician caring for the patient. The infant with severe persistent diarrhrea is steadily depleting his body store of potassium, and this loss must be made good. Govan and Darrow (1946), Butler and others (1946), and Flett and others (1949) have shown that replacement of the potassium loss is necessary in the treatment of infants with entero-colitis. Govan and Darrow (1946) have claimed an extensive reduction in the mortality rate with the routine use of potassium in all patients with diarrhrea, but their clinical experiment was not controlled adequately. It is very probable that it is only the infant who remains sick for some time in whom the potassium becomes so depleted that serious symptoms develop. The body has very considerable reserves of potassium, and as the average patient with entero-colitis can take milk feedings fairly soon, the routine administration of potassium to all infants with entero-colitis would seem unnecessary. The fact that oral milk feeding has been resumed early in our own hospital is probably the important factor in determining why serious potassium deficiency is not a common problem, for there were only 13 cases in a series of 496 sick Infants. However, it must be appreciated that the group of patients in whom the diarrhrea is severe and persistent, and who often vomit or have di1ll.culty in taking adequate quantities of fluid and milk by mouth, are in grave danger of developing severe potassium deficiency. The potassium losses in this group are not adequately replaced by the limited milk intake, so that in time a serious state of depletion occurs. It is this group of patients who require potassium therapy, so Its to prevent depletion from reaching a stage at which serious symptoms will arise. A simple method of prevention, and one that is now in use at the hospital, follows the principles laid down by Butler (1946). A solution containing 32 milliequivalents per litre of potassium, 50 milliequivalents per litre of SOdium, 40 milUequivalents per litre of chloride, and 10 milliequivalents per litre of phosphate in 5% glucose and water is administered orally to all children with severe entero-colitis as soon as they can absorb fluid by mouth and is continued in decreasing amounts until full-strength milk feedings are resumed. If the infant has had severe diarrhrea for five or six days or longer before admission to hospital and requires intravenous therapy, then it is wise to administer potassium intravenously pending oral administration of potassium to the child. A solution of N/4 sodium chloride with one gramme of potassium chloride, or a solution with sodium lactate, sodium chloride and potassium chloride to give approximately 40 milliequivalents per litre of sodium, 20 milliequivalents per litre of potassium and 30 milli· equivalents per litre of chloride supplies this need well.