From the data given above the following explanation of the effects of continued loss of the external secretion of the pancreas may be offered. The underlying event is a steadily increasing deficit of sodium and of chloride ion due to the large requirement for these electrolytes in the construction of pancreatic juice. In consequence there is continued loss of water, chiefly from the body fluids in which sodium and chloride ion are large factors of total ionic content, viz., interstitial fluids and the blood plasma. During about two-thirds of the survival period the volume and composition of the blood plasma remain approximately normal, the losses of water, sodium, and chloride ion being replaced at the expense of interstitial fluids. Reduction of the volume of these fluids is indicated by loss of body weight beginning directly after establishment of the pancreatic fistula. Ultimately reduction of plasma volume begins and, as it progresses, serious symptoms develop and death occurs unless water, sodium, and chloride ion are abundantly replaced. Owing to the relatively greater loss of sodium than of chloride ion in pancreatic juice, reduction of bicarbonate ion concentration in the plasma tends to occur. The death of the organism may be simply and reasonably explained as the result of progressive impairment of the function of the blood by the physical changes, dehydration and acidosis, produced in the plasma by the continued loss of sodium and of chloride ion in the pancreatic juice.

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