A THERAPY OF THE FUTURE FOR TROPICAL COUNTRIES:

QUINTON'S MARINE PLASMA

by H. de Lauture and Mbakob

Communication presented at the conference of Port-Barcars

La mer et ses bienfaits ("The ocean and its virtues"), october 1978

A THERAPY OF THE FUTURE FOR TROPICAL COUNTRIES:

QUINTON'S MARINE PLASMA (*)

by H. de LAUTURE (**) and G. MBAKOB (**)

If the mention of tropical lands evokes on certain occasions the image of lush regions drowning in luxuriant vegetation and washed by the
fish-rich and warm ocean - such an image reflects reality only in a fragmentary way. A large part of these lands is arid and far from the sea: and
this is particularly true for the African continent that forms a dense mass and is somewhat withdrawn into itself. And yet, even the most cursory
glance shows us that between the ocean and those regions that can be so distant, there are strong bonds because the sea invariably brings to
the population of these arid lands certain nutritional products such as salt or indispensible medications such as Quinton's*** Marine Plasma.

Today, we should like to emphasize this last aspect because this remedy, too often misunderstood, is a precious contribution to combat the
explosive infant mortality rate in a way that is efficacious and appropriate: as a matter of fact, it is downright specific as a treatment for infantile
dehydration and, because of its simplicity of operation, is particularly suitable to the constraints imposed by the environment of which we will
paint a rapid picture here. After recounting our personal experiences, we will discuss the reasons of its utilization.

*
**

The sanitary situation of the tropical countries, particularly those with a semi-arid ecology that comprises Asia, Africa and America between
latitudes 7 and 25 each side of the equator, are linked to the existence of ecological conditions that are eminently favorable to the development
of tropical or cosmopolitan diseases but unfavorable regarding any socio-economical development.

(*) Conference of Port-Barcarts (Pyrnes Orientiles), 5, 6, 7 October 1978: "La mer et ses Bienfaits".
(**) Preventive Medicinal Service and Public Health. Faculty of Medicine of Dakar.
(***) We will call it "Quinton's Marine Plasma" from now on [but we need to emphasize that the term seawater is
equally implied].

These diseases are predominantly of infectious or parasitic origin. Among the principal tropical endemics we can cite malaria, bilharzioses
(schistosomiasis), filariasis, trachoma, leprosy, cholera, sleeping sickness, yellow fever, intestinal parasitosis and, among cosmopolitain diseases,
the respiratory affectations as well as measles.

The frequency and seriousness of these affectations are facilitated by climatic conditions (temperature and humidity) that are certain facilitators
to the development of germs that provoke such diseases or are at least vectors that help spread them. Such climats contribute to create a very
aggressive environment and living conditions that are rather harsh.

Because of these climatic hazards, agricultural productions are often deficient and communications rendered difficult: this is why we find poor
populations, dispersed, isolated and undernourished. It is estimated that malnutrition due to protein deficiency affects one third of the African
black population, of the Extreme Orient and Latin America.
Malnutrition weakens the organisms and renders them particularly receptive to infections: and it is more or less directly responsible for half of all
deaths of children less than five years old. Malnutrition, infections, harsh climate and certain socio-cultural* traditions conspire to provoke,
among children, states of dehydration that, without treatment, have a fatal outcome.

Also, this unfavorable outcome of dehydration is so frequent because of a lack of sanitation. The latter is caused by a shortage of medication,
medicinal material and medical or para-medical personnel.

In certain regions of the Sahel (semi-arid regions), we encounter 1 medical practitioner for 200,000 inhabitants and 1 nurse for 50,000. The
circle of action of many centres exceeds 30 km and it is extremely difficult to reach these during the rainy season.

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 Very frequently is is impossible to practice intravenous perfusion in order to treat dehydration that often presents itself at acute stages for which
the classical I.V. drip is the only therapeutic and effective recourse. The reasons are numerous:

unavailability of a nurse who must consult with 100 to 200 persons in one morning
ignorance of the technique on the part of the person responsible for sanitation and often this is not even a nurse
insufficient supplies for perfusions

This is why, in 25% of all cases, children in the 0 to 3 year bracket succumb to conditions of acute dehydration. It is of utmost necessity to
improve this state of dehydration inasmuch as a child that escapes [this condition] gets well quite rapidly. Therefore, one must have recourse to
a method other than intravenous perfusions capable to either heal the child or to enable him/her to reach a competent medical centre - and that
[often] requires a delay of 24 to 48 hours.

( *) Here is where healers recommend a liquid diet for children with

measles.

Quinton Plasma that can be deeply injected intra-muscularly or subcutaneously seems to us THE ideal way to obtain these results.

*
**

Before we relate our personal experiences, we must review the clinical characteristics and bio-pathologies of dehydration. The fluid elements
comprise 70% of the human body's volume. These are divided into three compartments, or three major fluid spaces, that are relatively constant
(figure 1).

The interstitial fluids form "stricto sensu" the interior milieu or interior terrain: it is an aqueous solution in which our cells swim. Essentially, it is
not really a liquid and moving solution, but it is fractional liquid, not very mobile, of interstitial tissue that has the consistency of a gel. This is the
vehicle of all the elements that enable cellular life thanks to the fundamental exchanges that establish themselves relative to the cellular
membrane: it provides the energetic and structural materials that are so indispensible for their development: it also permits waste drainage
towards the excretion territories [eliminative organs].

One if its main characteristics is its homogeneity, so indispensible to the normal functioning of the regulatory systems of cellular activity. The
homogeneity is maintained by the constant exchange with the tissues and with blood and it is this [blood] that retains the best reflection [of this
process]. It is no such thing as an actual pathology, [only] its derangements [perturbations] that are the consequence of functional abnormalities
for which it is not [even] responsible.

The liquid territories should not be considered as absolutely delimited territories: they are in constant inter-penetration. Moreover, we can
distinguish certain distinct sub-territories with defined organs (Figure 2).

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 In practice, we often join the first two terms under the denomination: extra-cellular medium in contrast with an intra-cellular medium [terrain or
milieu].

The masses of these fluid compartments are not proportionally identical to those of their volume (Fig. 3)

For an adult, the daily need for water is [about] 35 ml/kg/day. This is evidently linked to climatic conditions, [diet] and the surroundings.

For subjects with diarrhea and vomiting, if the [liquid] losses are not compensated, one can see dehydration appear. This is due to the fact there
there are no longer any [liquid] reserves.

This risk appears much more frequently with nurslings whose needs for water, with respect to their weight, are much higher than those of an
adult. A nursling's liquid equilibrium is much more fragile: Consider - a nursling of 7 kg whose extra-cellular liquid volume is in the order of 1,400
ml, water intake and excretion would reach about 700 ml per day, while with an adult of 70 kg whose extra-cellular liquid volume would be
around 14 liters, this same movement [intake and output] would approach 2 liters only.

Usually, dehydration is due to a simultaneous loss of water and electrolytes. In general, a metabolic acidosis, following a loss of mineral cations
(Na+) and of bicarbonates, ensues and accompanies the dehydration - each aggravating the other.

Acidosis entrains increasing excretion of mineral cations (Na+ and K+) - partially because excretion of quantities of excess acids in the urine
necessitates more abundant excretions of cations thus exceeding the possibilities of renal amniogenesis (formation of the amnion) that has, as its
purpose, the task of storing mineral cations.
Acidosis also entrains increasing excretion of mineral cations (Na+ and K+) because acidosis augments cellular catabolism by liberating
potassium (K+). These losses of mineral cations contribute to the development of dehydration and when the mineral cations are excreted in the
form of buffered salts (e.g. as phosphates), they constitute a supplementary cause of acidosis.

Concomitantly, a metabolic alkalosis can manifest itself in diarrhetic children that vomit, because this vomiting causes a loss of hydrochloric acid
of the gastric juice. This can then result in a free-fall of intra-cellular potassium and an increase in intra-cellular sodium.

If the organism loses as much chlorine as it does of sodium, then we see neither acidosis nor alkalosis because the losses complement each
other.

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 Therefore, dehydration and acidosis entrain an ionic transfer, and they present sources of imbalance between liquid compartments. Maybe it is
necessary to review how those transfers take place...

The exchanges between the extra-cellular and intra-cellular spaces take place through the walls of the capillary vessels. It seems that they
heavily depend on hemo-dynamic factors of which an overview is provided in the well-known Starling schematic.

At the level of the cellular membrane, three kinds of transfer exist:

active transfers
passive transfers
enabled transfers

The active transfers represent an essential biological phenomenon: they help the cell maintain its individuality. The sodium and potassium
transfers are a good example: if the Na concentration is around 140 mEq in the extra-cellular environment, then it is only about 25 mEq within
the cells; and conversely, the concentration of potassium, being around 5 mEq within the extra-cellular environment, rises to 130 mEq within
the cell.

This is due to an active expulsion of sodium out of the cell and an active attraction of potassium into the cell. This expulsion is the work of a
membranous enzyme, "Na+K+ AT Pase" which is the [active] agent of what has commonly become known as "the sodium pump".

The existence of analogue mechanisms have been demonstrated for other cations such as calcium and magnesium.

Let us point out that these transporters bing into play certain enzymes and facilitators that contain [or make use of] trace elements, [also known
as oligo-elements].

The passive transfers are based on diffusion. They can be simple; this is the case of chlorine or [where] modified by membranous polarization.

They can be aided by ionophoric and similar substances [these help the transport of ions across cell membranes].

Some of these are known: these are neutral cyclical compounds the radical hydrophobes of which occupy the periphery of the molecule, while the
central part is polar, such as Noactin or Valisomycin, or certain antibiotics such as Nystatin and Amphoteric B [an amphoteric substance is one
that can react with either an acid or base (more generally, the word describes something made of, or acting like, two components].

The facilitated transfers do not consume any energy and and do not take place against a concentration gradient. They are aided by transporters
that have receptor sites on which agents to be transported fix [attach] themselves.

The most important source of energy assuring these transfers is due to ATP being mobilized by enzymes called ATP-ases, but other processes are
thus set in motion such as those that call upon dehydrogenase.

We see therefore that, in cases of dehydration, multiple upheavals are produced: those that affect certain ions are known but what about the
transporters, the enzymes that activate them and the trace minerals that enter into the constitution of these enzymes?

Depending on the quantity of water and electrolytes lost, we see a classical distinction between three types of dehydration:

hypertonic
hypotonic
isotonic

Hypertonic dehydration is observed with patients who lose an important quantity of water (diarrhea) and cannot compensate for this loss
(vomiting). Here we have an initial loss of hypotonic liquid: the volume of extra-cellular liquid is reduced and has become hypertonic.

There is a compensating displacement of intra-cellular space toward the extra-cellular space up to a level of osmotic equilibrium: the arriving
osmotic concentration remains higher than that of the normal liquid. As a matter of fact, the vascular compartment maintains just about its
volume thanks to the retention that is due to the plasmatic proteins and it is the volume of the interstitial compartment that diminishes (figure
4).

The clinical signs are summarized in Table I. The cerebral lesions are particularly important.

The electrolytic perturbations are given in Table II.

One sees this kind of dehydration in 20% of children having diarrheal dehydration.

Hypotonic dehydration results in a preponderant loss of salts. This follows a hypertonic dehydration where one replaces only the water losses
and not the loss of salt. One can see this in 10% of cases of diarrheal children accompanied by dehydration.

The compensation of extra-cellular hypotonicity that is produced hereby starts in the intra-cellular space by:

an exit of intra-cellular potassium into the extra-cellular environment,

a diminution of osmotic intra-cellular activity by the inactivation of intra-cellular cations, probably because of the formation of chelates,
a displacement of water from the extra-cellular space toward intra-cellular space, until a new osmotic equilibrium is created...

...and thereby one observes a loss of cellular potassium and a massive cellular dehydration: such is the case with losses of secondary potassium
at lesions of the digestive tract. What is hereby reduced is:

the total quantity of potassium

its intra- and extra-cellular concentrations (Figure 4).

However, its urinary elimination is increased.

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 The clinical signs are summarized in Table I and the electrolytic perturbations in Table II.

In 70% of all cases of dehydration accompanied by diarrhea, one finds isotonic dehydration: In this case, the losses of water and electrolytes
are equivalent with the result that the global composition of the liquids of the organism remain practically normal, even if there is a serious case
of acidosis

Hypertonic Hypotonic Isotonic

Dehydration Dehydration Dehydration

Skin Color Gray Gray Gray

Temperature Lowered or raised Lowered Lowered
Turgescence Normal Very little Little
Sensation when Firmer than normal Moist or clammy Dry
touched

Mucosae Dry Slightly moist Dry

Eyes Sunken Sunken Sunken

Fontanel Depressed Depressed Depressed

Psyche Hyper-excited Coma Sleepy

Pulse Accelerated Rapid Rapid

Blood Pressure Lower than normal Very low Low

Table I - Clinical Signs of Dehydration

H2O Na K Cl
(*) (**) (**) (**)

Hypertonic 100 - 2-4 0-4 2-6

Dehydration 120

Hypotonic Dehydration 100 - 10 - 8- 10 -

120 12 10 12

Isotonic Dehydration 100 - 8 - 10 8- 8 - 10

120 10

(*) = mEq/l
(**) = mEq/kg

Table II - Hydro-electric Deficits

Because the lost fluid is isotonic, there is no compensating displacement and the loss of biological isotonic liquids concerns mostly the extra-
cellular space (Figure 4).

The clinical signs and the electrolytic perditions are given, respectively, in Tables I and II.

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 This brief recall shows us that the only clinical test, even if it does not permit a choice between the 3 types of dehydration, still enables a
dehydration diagnostic. In most cases, one deals with a child that exhibits:

a dry and rough skin

a depresses fontanel
sunken eyes
a state of indifference, without a smile but obsessed and with ceilingward stare
anorexia
diarrhea
vomiting.

It is these signs that permit us to clinically follow our patients.

*
**

We present here the results that have been obtained using intra-muscular injections of Quinton's Marine Plasma [also known as Ocean
Plasma] with 100 dehydrated children, treated in a rural Health Station situated in the Senecal Sahel (semi-arid region) about 60 km from
DAKAR* and chosen as a random sample.

This Health Station has a radius of action of about 15 km. Each day of the week, except Sundays, 3 nurses and 5 aides take care of from 100 to
200 ambulatory patients of which 3/4 are children from 1 to 15 years of age and half of these children are from 1 to 5 years old.

Each patient benefits from a consultation, eventual care or a treatment lasting 1, 2 or 3 days depending on the case, paying a fee of 100 F. CFA
(2 French Franks) adapted to the local resources, the annual per capita revenue being around 60.000 F. CFA (1.200 FF).

Straightaway, the clinical signs of dehydration, more or less accentuated, but always present in totality or in part, was observed with every one of
these children, frequently associated with signs of malnutrition.

Invariably, we found at least the first two elements of the triad: anorexia, diarrhea, vomiting.

(*) Poste de Sant de Keur

Moussa.

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 These observations are regrouped in Figures 5, 6 and 7 and Table III as well as the data concerning age, sex, weight and height of each of these
children.

Figure 5 shows that:

94% of the children were less than 2 years old

56% of the children were less than 1 years old
there were two groupings, one of about 8 months, and the other around 18 months.

These [groupings] are probably related to problems of nutrition; at around 8 months or so, mother's milk is no longer sufficient and if she has not
started to supplement her baby, it finds itself undernourished; at about 2 years of age, it is the stage of definite separation, sometimes realized
in a brutal fashion, and it entrains nutritional insufficiency followed by undernourishment: these two periods engender a fragility and a reduction
in resistance to infections.

Figure 6 shows that:

98% of children weigh less than the weight reference curve

31% weigh less than 66% of the norm of the reference curve and would justifiably be candidates for hospitalization. This is why one finds
children that are 2 and even 3 months old and they weigh less than 3 kg.

Manifestations
Present
(for 100 patients)

Cutaneous wrinkles 96

Depressed cranium 62
(fontanel)

Sunken eyes 67

Obsession with upturned 22

eyes

Irregular respiration 5

Anorexia 78

Diarrhea 86

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 Vomiting 83

Table III - Frequency of observations of clinical symptoms during infantile

dehydration

Figure 7 shows that the height of these children are also inferior to the expected averages, and this particularly for the higher ages. So, we are
dealing here with children who have been subjected to repeated aggressions and who have especially suffered from malnutrition.

The spread as per sex is:

65% boys
35% girls...

...and this shows that there is a predominance of boys. This is a situation that we have repeatedly encountered in numerous clinical
consultations. This disparity can result from a more acute fragility in boys because often they receive more attention.

Table III shows the frequency with which symptomatic clinical manifestations have been found. One sees that the triad: anorexia - diarrhea -
vomiting, stands out with much importance.

We have not encountered any comatose children.

With all children, the tongues was coated and the skin dry. None was smiling, all were morose or indifferent.

Signs of marasmus [wasting away] with edema were found with 13 children and also signs of Kwashiokor, with muscle wasting cutaneous signs
with 7 [children].

With 31 children we saw an associated broncho-pulmonary infection, two of which with whooping cough; 17 had otitis; 23 had paludism
[malaria]; 13 had dermatosis; 5 were convalescing from measles.

Anemia involved 45 children and 8 had inferior hematocrit at 27.

Three children were premature with respective weights of 1 kg 500 g at one month, 1 kg 900 g at 1 month and 1 kg 700 g at 3 weeks of age.

We did not encounter any cardiac abnormalities when auscultated. The pulse rate was accelerated from 100 to 130, also mostly due to the
inherent emotion of an examination. Temperatures varied from 362 to 385 in the morning.

*
**

Quinton Plasma had been injected intra-muscularly into the Deltoid muscle while the child was being held in its mother's arms. This injection site
permits the introduction of a decent quantity of liquid in an area where diffusion can easily and rapidly take place, and without provoking
superficial puffiness that happens with subcutaneous abdominal injections the view of which is disagreeable to the mothers. Also, the risk of
superficial infection is less acute than in the sub-umbilical area.

The therapeutic modalities had to take into consideration the environmental conditions and particularly the difficulties to communicate. We were
dealing with children living an average distance of 15 km away, linked with the clinic by paths that were sometimes difficult to negotiate in the
rainy season during which the food supply is the least favorable. Sometimes, in order to bring their children, the parents can use small service
cars for part of the way or, if this is not possible, they have to come in carts or less often in carriages, and they might take 2 hours to cover 10
km.

Therefore, it is not possible for the children that are more than 10 km distance away to return every day in order to receive an injection. Coming
back every second day already imposes heavy hardship on the mothers who have to take care of several children and for whom it is impossible,
even inconceivable, to devote an entire day to one single child.

One can also not imagine, except in exceptional and isolated cases, to keep the children in order to give them an I.V. drip: the health centres are
not equipped for this and the mothers cannot stay with their children because they are impatiently awaited at the village. At any rate, there is
nobody in the villages who could possibly give the injections. Therefore, it is necessary to administer, if appropriate, oral mobile [travel]
treatments and, in the case of injections, to give them at the Health Centre.

In order to decide a frequency of injection, we had to take into account the availability of the family, in other words, how far they live. To decide
the quantity of Plasma to be administered at each injection, we had to base ourselves on this constraint; but otherwise we guided ourselves by
the child's weight and, above all, its weight deficit.

We adopted the following plan:

During the first week:

Kilograms Gravity (of condition)

Average Severe
(Weight Loss <33%) (Weight Loss > 33%)

<2 kg - 2 x 10ml/day every 2 days

2 to 5 kg 2 x 20 ml/day every 2 2 x 30 ml/day every 2

days days

5 to 9 kg 2 x 30 ml/day every 2 2 x 50 ml/day every 2

days days

During the second week: Medium severity cases are given treatment, except for nurslings whose weight is less than 2 kg and on those we
provide treatment that is applicable to severe cases; the frequency [of treatment] is 2 times a week

At the first injection: sometimes, we double the dose for a dehydrated child

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 Otherwise, general or local antibiotics as well as antiseptics were given depending on the applicable case.

One can see that this kind of treatment is very far from the recommendations formulated by Quinton and by Jarricot who did daily injections
during the first two weeks followed by twice a week for 3 or 4 weeks, with doses that were adapted with precision to the weight of each child.

Despite the difficulties to apply an ideal therapy, the results have been very good, even beyond hope and expectation for our 100
observations.

First of all, immediately after the first injection, all children were thirsty, even those that were anorexic: this allowed subsequent oral rehydration.
This is a moving sight to see, those children, with indifferent and unexpressive stares, sometimes turned upward, suddenly produce sucking
sounds and immediately absorb 200 to 300 ml of liquid.

It is quite evident, that the best rehydrator, intrinsically, would be sweet Marine Plasma, however, because of the very precarious living condition
of the population, unfortunately is is not possible to envision this possibility. We recommend to the mothers to give either sweetened salt water,
milk, liquid "Monkey Bread" (a local fruit, carried by the 'baobab', that is very astringent and has an agreeable taste), or rice water.

During the following hours, diarrhea and vomiting cease in the majority of our cases.

The very next day, we see a recommencement of weight increase that varies each day between 50 and 100 gr.

In numerous cases, the improvement is so convincing that many parents failed to bring back their child for follow-up injections in the second
week.

The results that were obtained are recorded in Table IV.

As an example, we provide the following observations:

K... S... ; Sex: F. ; 1 Month of age; 0,48

m

7.8 (Date?) 8.8 9.8 10.8

Weight (kg) 2,050 2,100 2,150 2,200

Skin wrinkles ++ + +/- +/-

Fontanel Depressed (+) N N N

Eyes Hollow N N N

Vomiting ++ + 0 0

Anorexia ++ + 0 0

Diarrhea ++ + 0 0

Consciousness N N N N

Observation of Infant K... S...

1st 3rd 5th

Day Day Day

Skin wrinkles 96% 71% 37%

Depressed fontanel 62% 23% 0

Hollow eyes 67% 11% 0

Obsession with upturned 22% 0 0

eyes

Irregular respiration 5% 0 0

Anorexia 78% 0 0

Diarrhea 86% 18% 3%

Vomiting 83% 5% 0

Table IV - Improvements of symptomatic clinical manifestations of dehydration when injected with Quinton's Marine Plasma
[also known as Ocean Plasma]

What would have been the future of these children if we not have had the possibility of utilizing Quinton Plasma? It is evidently impossible to
answer this question, however, the experience of Health Care Centres that were deprived of Quinton's Marine Plasma, and therefore deprived of
I.V. drip possibilities, lead us to conclude that the mortality rate would have been between 40 and 70%.

It is necessary to insist on the fact that Quinton's Marine Plasma enables all our sample children to recover without recourse to hospitalization:
while we were looking at this therapy as a means to prolong [the existence] of these children until they could have I.V. perfusions administered,
it revealed itself capable, all by itself, to remedy acute states of dehydration.

How can we explain these results? Would physiological serum [saline solution] have given the same results? We did not conduct this research on
a sample lot, given the difficulties to remedy a possible aggravation of the health state of the children in the conditions of the work at hand.

The response to this line of questioning will come to us when we study the principles of rehydration, the needs of the organism and the
contribution of Quinton's Marine Plasma.

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 **

The purpose of rehydration is to restore the fluid losses incurred by the extra- and intra-cellular sectors and to make up for the losses of
electrolytes and eventually to correct the level of acidosis and alkalosis [pH].

Very often, and this was the case with our patients, it is impossible to proceed with a rehydration per se and it is necessary to have recourse to a
parenteral rehydration. This should respond to three prerequisites:

provide for normal needs

compensate the previous losses
compensate for present losses.

The constituents of the solutions should be chosen in such a way as to ensure that the existing deficiencies are corrected without overloading the
organism.

The solutions that are normally used contain either anions, or cations such as chlorine, potassium, sodium, or sugars. It is possible to classify
these in the following way:

1. Simple solutions
2. Poly-ionic solutions

For simple solutions, one finds in particular:

physiological serum [saline solution]

glucose serum
sodium bicarbonate
ammonium chloride.

For poly-ionic solutions, one can cite numerous others:

Ringer solution
"Rhiger-lactate"
Darrow solution

What is the value of these solutions?

Their usefulness is undeniable, however, the opinions on their efficacy should be modified. Let us quote the appraisal of FLEISCHER and
FRHLICH concerning physiological serum: "This solution, despite the fact that its name is not at all physiologic [being in accord with or
characteristic of the normal functioning of a living organism], except for the fact that it is isotonic to the extra-cellular fluid. The concentration
ratio of isotonic sodium and chlorine is 3/2 in the extra-cellular liquid while it is 1/2 in the isotonic solution of sodium chloride..... An attempt at
rehydration using large amounts of sodium chloride solution is therefore inefficient and carries harmful consequences. The highest tolerance to
sodium chloride is in the order of 225 to 250 mEq/m2/24 hr. Now, 1.500 ml of isotonic NaCl solution contains 225 mEq of sodium; this adds up to
400 ml of free water per m2 of body surface in this volume of solution (after elimination of the electrolytes and the volume of corresponding
water) or not even half of what is necessary to compensate the necessary losses..."

"Among all the injectable solutions, the injectable solution of sodium chloride has for a long time been considered as the most important one and
even though its inconveniences are well known, it is still the favorite among numerous clinicians" (2).

In order to reduce the inconveniences, one can have recourse to the poly-ionic solutions, but their efficacy is also doubtful; this is, for example,
the opinion of the same authors concerning the Ringer solution: "...despite its content in magnesium and on calcium, this classical solution has no
advantage over the isotonic sodium chloride solution, but it has all of the inconveniences" (2).

Rehydration by intravenous manner is in fact a delicate operation that requires:

knowledge of how to administer a drip, possession of adequate materials and to be able to work in satisfactory aseptic conditions.
to know with precision the liquid quantities and electrolytes to inject, therefore to be able to determine the corporeal surface of the subjects to
rehydrated because this knowledge is far better than that obtained using only the weight data, and to know the losses in electrolytes and for
that to be able to administer the necessary biochemical dosages with good precision.

Most often, these conditions do not [even] come together in the developing countries where, nevertheless, cases of dehydrated children happen
very frequently: so, it is not possible to call upon these rehydration techniques.

A rehydration method that is really well suited should base itself on the following principles:

it is preferable to correct the osmotic losses before the liquid losses because the electrolytic concentrations are more important for the
physiological functions than their global result.
the electrolytic quantities that need to be provided are based on the extra-cellular electrolytic concentration values, and do not take into
consideration the extra-cellular environment that cannot be easily calculated; therefore, one runs into frequent risks of overload; and to avoid
this risk it is preferable to adhere to an insufficient therapy instead of applying an excessive one.
the parenteral path should remain an exception and its utilization should have as its goal to come back, as quickly as possible, to the oral
method [of administration]. Therefore, it is necessary to deal with anorexia and to provoke in the nursling a feeling of moistness that follows the
reduction of the intra- and extra-cellular fluid volumes, and also the increase of extra-cellular osmotic pressure.

It is therefore evident that a composition mix that is similar to blood, at least as far as electrolytes are concerned, would be the most appropriate
in order to avoid these risks: this is the case with Quinton's Marine Plasma, but, among other things, it provides substances other than
electrolytes and in those there is a vivid interest.

Quinton's Marine Plasma [or Ocean Plasma]

Quinton's Marine Plasma is seawater rendered isotonic (9 p. 1000) by the addition of distilled water [Note by translator: filtered spring water is
better]. This seawater is harvested at a depth of 10 to 30 meters off the S-W coast of France.
[Note by translator: Seawater is now also harvested in Canada - in the Eastern Atlantic ocean.] It is then diluted with apyrogenic
distilled water [Note by translator: Canadian seawater is diluted with reverse-osmosis water].
Afterwards, it is filtered to 0,2 microns. All these manipulations are accomplished in a sterile laboratory atmosphere and using non-metallic
equipment.

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 Figures 8, 9 and 10 represent a comparison of the principal electrolytes of the intra-cellular liquid, of blood, and of Quinton's Marine Plasma and
they show us a narrow concordance between these three environments: Quinton's Marine Plasma seems like a true interior 'milieu' [terrain].

Isotonic seawater is much more complete than the physiological serum and it contains cations that are indispensible to the muscular metabolism.
Let's remember the unique experiments of one of our team, carried out in 1960 (4) and re-enacted from those done by of LOEB and of
JARRICOT.

We remarked certain facts with the hearts of turtles, I.V. dripped via the venous sinus, and these are explained in figure 11:

1) a simple isotonic chlorinated plasma solution is toxic and we see a slowing of [cardiac] contractions that can reach complete arrest.

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 2) after a wash with adrenalinized physiological serum, the hearts were perfused with a solution that was comprised by the three chlorines:
NaCl, KCl, CaCl2, in such a proportion as is found in seawater. The heartbeats came back to normal and this showed that the potassium and
calcium salts are antagonistic with respect to chlorine and sodium.

3) When perfused with isotonic seawater, the heartbeats became amplified and attained a very good rhythm.

This experiment shows in a very clear manner that a poly-ionic combination that contains the principal cations of seawater is a better biological
terrain for living cells while the Ringer liquid and even more so the physiological serum are toxic mediums [terrains].

It is therefore very possible that the physiological serum perfusions can very often be a noxious therapy that forces an already unbalanced
organism to fight against a new disequilibrium while this is not to fear with Quinton's Marine Plasma (Table V).

Besides the fact that physiological serum has, by itself, a certain toxemic effect, it is either given in an empirical manner, or is given while
referring to an ionogram: Also, we cannot over-emphasize that this latter measure, practiced only rarely, cannot provide any information
concerning the two only elements that are indispensible to know and these are, on the one hand, the relationships between the ionic intra- and
extra-cellular concentrations and, and on the other hand, the efficacy of the metabolism.

In the absence of such information, instead of drawing an unbalanced conclusion, it is preferable to seek a balanced contribution and this is
possible with Quinton's Marine Plasma.

Effects Ca++ K+ Mg++ Na+

On the Colloids Prevents movements of water Solidification effect Same effect as Liquifaction of Colloids
Ca++

On the Sympathetic Excitation of the Autonomic Excitation of the Parasympathetic Sedative effect Excitation - replaces Ca++
Nervous System Nervous System Nervous System

On the Central Nervous Neutralizes Na++ Paralyzing effect Sedative effect Excitation
System Balances Mg++

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 On the heart and vessels Exciting Sedative - provokes Bradycardia Anti- Exciting
contractural

On Inflammations Anti- Anti- Anti-allergic and Augments disposition toward

inflammatory inflammatory anti- inflammations
inflammatory

On Thermal Regulation Causes hypothermia Causes Excess causes sodium fever

hypothermia

Other effects Causes obstruction of vessels Diuretic and anti-allergic Choleretic and
anti-
arteriosclerotic

It is quite evident, that, besides the major electrolytes, other elements that are less abundant but have a biological effect that is essential to life,
such as the trace elements, will be found disrupted during the course of a dehydration.

As one can see in Table VI, these electrolytes are essential to the functioning of various enzyme promoters or regulators of the biological activity:
we find these in Marine Plasma!

One can therefore postulate that Marine Plasma is the therapy of choice in order to obtain a balanced supply of trace elements for dehydrated
patients.

During dehydration, the cellular membranes are profoundly deranged: as a matter of fact, during the electrolytic drainage we find ourselves
before a veritable transition that runs counter-current to their [purpose]. The mechanism of active [fluid] transfer, such as the "sodium pump"
are supplanted and probably damaged. There can even be destruction or drainage of certain enzymes, and it is therefore futile to substitute for
them. However, in Quinton's Marine Plasma we find numerous organic elements of which certain ones are apt to participate actively with the
metabolism.

The research into these organic marine compounds is still in its infancy. Basic research has been done in France by CERBOM* and we will refer to
them as reference.

(*) We particularly thank Mr. Gauthier for the information he gave

us.

Quantity in micrograms/liter...

Elements ...in ...in ...in Marine Physiological

Blood Tissues Plasma Functions

Aluminium 4 1 2 Activates dehydrogenase

Arsenic 1 6 1 Activates porphyrins

Silver 0.04 0.01 0.01 Activates Enolase

Boron 2 6 0.1 Activates Esterase

Cobalt 0.2 0.03 0.03 Activates Phosphatase

Copper 0.03 0.01 1 Activates Phosphatase

Iron 1.5 0.5 3 Activates

Enolase & Esterase

Fluorine 4 1 4 Activates Enolase

Iodine 2 0.2 20 Activates colloidal substance

Lithium 2 5 50 Activates enzymes of muscular

cells

Manganese 0.1 0.1 0.7 Activates Phosphatase

Nickel 0.1 0.1 0.7 Activates Phosphatase

Phosphorus 200 200 20 ADN

ATP

Silicon 0.1 0.1 1000 Balances REDOX

Zinc 0.5 0.3 3 Activates

carbonic anhydrase

Table VI - Electrolytes -
Traces in Blood, Tissues and Marine Plasma.

These compounds are produced by the phyto- and zoo-plankton. They participate in the regulation of biocenoses and, because of this fact, they
have been named "chemical telemediators". They are in this case "substances that are synthesized by the marine species, whether animal or
vegetal, liberated within the environment and acting remotely on the behavior or biological functions of the same or other species (1)".

Despite the fact that often their activity has been noticed, their biochemical analysis is often only fragmentary. Yet, one managed to isolate:

pyrrolic compounds, bromines that have an antiseptic effect such as bromo-pyrrol

sulfur compounds
poly-anionic substances coming from a group of bacteria that is often seen in the marine environment: the alteromonas. They have a high
molecular weight and contain a large proportion of polyoside acids. They have an antibiotic effect on bacteria that are gram positive.
exo-cellular lyric enzymes, on microbian germs and yeasts,

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 volatile compounds: fatty acids, terpenes and carbonyl; acrylic acid is the oldest one known of the marine fatty acids (1951); the terpenes are
also the object of a series of researches and have lately a cyclopropane has been isolated that contains a serquiterpene. These are produced by
the dinoflagelates, the cyanophyces and the chrysophyces.
polysaccharidic compounds of high molecular weight that could comprise a uronic grouping
peptides and nucleosides
anti fungal substances

It is not possible to presently know the role of these tele-mediators on the organism because no research has been done in this direction; but
when one knows the role that certain polyanionic antibiotics play, as facilitators or inhibitors in the enzymatic phenomenon that enable
electrolytes to breach the cellular barrier, then one can realize that some of these can be found in seawater and Quinton's Marine Plasma.

And finally, the acid/base equilibrium and the buffering effect of Marine Plasma are supplementary factors of interest:

The pH of Quinton Plasma is 7,4 and is therefore identical with that of blood.

Let us remember that the buffering effect is measured by the relationship - dC divided by dpH where dC is the strong acid or strong base quantity
that is necessary to make pH vary by dpH of the considered solution.

One calls "buffering substances" or more simply "buffers" those substances in solution that are capable of cushioning or reducing the variations of
the pH that this solution would exhibit with the addition or reduction of H+ ions.

The biological liquids and in particular that of blood are buffer substances and this quality is a necessity for them in order to cushion the brutal
modifications that can come from the exterior environment.

The buffering value of a solution is the quantity of H+ ions that can be added to or subdivided from this solution to observe a change of the unit's
pH: And this is not negligible for Marine Plasma.

The properties of Quinton's Marine Plasma and its ease of administration make it a therapy of choice in dehydration of children.

Even if it is impossible or harmful in most cases to have recourse to intravenous perfusions [drips] of physiological serum, certain [professionals]
remain attached to this theoretical paradigm, because they learned it this way, and in order to defend this stance they could pop the question of
the cost of the rehydration [process] by means of Marine Plasma compared to that of rehydration by physiological serum.

[Written in 1978] The hospital cost price of a litre of [physiological serum is about 250 F. CFA (5 FF); therefore, to equal this price with Ocean
(Quinton) Plasma one must use 250 ml of this product, the value of which is 240 F. CFA (i.e. 4,80 FF): this quantity is largely sufficient to assure
a rehydration that will be pursued per se.

If one takes into account the necessary material to do a perfusion and the higher cost price of the intra-venous perfusion, one can see the
advantage the is evident with the use of Ocean (Quinton) Plasma. Whether this is on the triple plan of the therapeutic value, the pharmaco-
dynamic effects or the cost price, it is evident that everything conspires in favor of the Ocean (Quinton) Plasma in the infantile rehydration and in
disfavor of physiological serum. We estimate that, given the interest of cost/efficacy of Ocean (Quinton) Plasma in the rehydration of children for
Third World Countries, it is of paramount importance for Public Health Departments to know this therapy.

BIBLIOGRAPHY

1 - AUBERT M. Tlmdiateurs et rapports inter-espces dans le domaine des micro-organismes marins. CERBOM - Nice 1976.

2. FLEISCHER W. and FRHLICH E. L'eau et les lectrolytes dans l'organisme, 1 vol. Masson Ed.. Paris. 1965.

3. IVANOITA. Introduction l'ocanographie. Tome 1 Vuibert Ed. Paris. 1977.

4. LAUTURE H. (de) Allergothrapie marine et thalassothrapie la lumire de travaux exprimentaux et de 600 observations, 1 vol.,
Sammarcelli Ed., Bordeaux. 1960.

5. NELSON W.E. Trait de Pdiatrie. 3 vol. Maloine Ed., Paris. 1961.

6. PELLET M.V. Physiologie du milieu intrieur, 1 vol. SIMEP Ed.. Paris. 1977.

7. QUINTON R. L'eau de mer - milieu organique, 1 vol. Masson Ed., Paris 1912.

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