Glycerin to lubricate tube.
Mouth gag, if necessary, or roll of bandage to hold jaws apart.
The baby should be wrapped tightly (Fig. [180]) to prevent interference by his struggling and turned slightly to the left side. (Fig. [181].) The catheter is lubricated with glycerin or water and passed back over the tongue and quickly downward until an air bubble is heard as it enters the stomach. The length of tubing which is to be inserted may be anticipated by marking a point on the tube which is the same distance from the end as the baby’s mouth is from its umbilicus. The possibility and the serious consequences of introducing the tube into the trachea instead of into the esophagus must be borne in mind. Although the baby will often choke and struggle when the tube is properly introduced, he will not cough violently and stop breathing as he will if it enters the air passage. Further information is obtained by inverting the funnel in a basin of water after the tube is inserted; if it is in the stomach there will be no result, but if it is in the trachea air will be expelled and bubbles will rise through the water. To wash out the stomach, the funnel is filled with warm water and slightly raised so that the water will run in slowly, after which the funnel is turned upside down into a basin which is lower than the baby’s body, and the stomach contents allowed to run out. This is repeated four or five times, or until the solution returns clear, and the food which is to remain in the stomach is poured in slowly. Before the tube is quite empty it is pinched off with the fingers and quickly withdrawn.
Acidosis. The diarrheal diseases are sometimes complicated by acidosis, a condition in which the relative amounts of acid in the blood are so increased that the normal alkalinity is markedly diminished. This condition may result from an excessive intake of acids; an overproduction of acids in the course of normal metabolism; a decrease in the reserve of normal alkali in the body or a failure in the mechanism by means of which excessive acids are usually neutralized or eliminated. Acidosis is a serious complication and often fatal.
Fig. 182.—Method of obtaining a fresh specimen of urine in a test tube.
The treatment is directed toward preventing the production of more acids within the body; restoring the alkali reserve and promoting elimination of the excessive acids and their salts. Solutions of glucose, bicarbonate of sodium and salt are used and are given by mouth, rectum, intravenously and intraperitoneally. Subcutaneous injections are not wholly satisfactory, because of the small amounts which may be given in this way. From 150 to 400 cubic centimetres are given into the peritoneal cavity and as the solution absorbs readily these injections are sometimes repeated every eight or twelve hours, an infusion bottle and short infusion needle being used. From 75 to 300 cubic centimetres of glucose solution (5 per cent. or 10 per cent.) is given intravenously, while as much as 1000 cubic centimetres is sometimes given per rectum in the course of 24 hours by the drip method. Soda solution (4 per cent.) is often given by mouth, if the baby is able to retain it, or intravenously, as frequently as the condition of the urine indicates is necessary. From 75 to 100 cubic centimetres is given at one time to young babies.
Fig. 183.—Obtaining a 24–hour specimen of urine through curved glass tube attached to rubber tubing which empties into bottle tied to side of bed. (From photographs taken at Johns Hopkins Hospital.)
