124 



METABOLISM IN SEVERE DIABETES. 



cetic acid reaction and the carbohydrate balance were essentially the same, but 

 there was a fall in the ammonia-nitrogen nitrogen ratio; there was, however, 

 a considerably lower metabolism, inasmuch as but 160 c.c. of oxygen were 

 consumed per minute, the pulse-rate was 57, and the alveolar carbon-dioxide 

 tension was 26 mm. Unfortunately the /3-oxybutyric acid was not determined. 

 In examining the original table for this case (table 33) we find varying 

 days, even when the subject was supposed to be fasting, the variations in the 

 oxygen consumption ranging from 179 down to as low as 160. These high days 

 can not always be sharply designated as being days on which no food was 



Table 133. Comparison of the metabolism of Case N under varying conditions of acidosis. 



taken, as we have reason to believe that the subject took food on one or two 

 occasions before coming to the laboratory, either through a misunderstanding 

 or otherwise, and it was not properly reported. In any event, the relationship 

 between the intensity of the metabolism, the diet of the previous day, and the 

 general physical condition of the subject was such as to be of considerable 

 significance, and seemed to indicate a rather close connection between the 

 severity of the acidosis and the intensity of metabolism. 



With Case Q we are confident that the diet was properly controlled. We 

 have accordingly selected two days with this subject in which both the degree 

 of acidosis and the total metabolism were determined. The results are given 

 in table 134. Under these conditions we find on November 18-19, when there 

 was severe acidosis with a large amount of /3-oxybutyric acid and a low carbo- 

 hydrate balance, that the metabolism and pulse-rate were considerably higher 

 than three days later, when the /3-oxybutyric acid was two-thirds that of the 

 first and the positive carbohydrate balance was considerable, this day being a 

 carbohydrate oatmeal day. There was likewise an increase in the tension of 

 the alveolar carbon dioxide. On the other hand, the whole comparison is some- 

 what complicated by the fact that the volume of urine on the second day was 

 but one-half that of the first day ; the total amount of nitrogen was also lower. 

 This of course would keep up the high percentage of ammonia nitrogen, and 

 might account for the low excretion of /3-oxybutyric acid, but need not neces- 

 sarily affect the carbohydrate balance. It is much to be regretted that other 

 experiments without food could not have been made with this subject, but the 

 only other two experiments obtained with him were after definite feeding. 



The results of the experiments with Cases N and Q strongly suggest an 

 intimate relationship between the severity of diabetes and high metabolism; 



