134 



METABOLISM IN SEVERE DIABETES. 



in the carbon-dioxide tension to 37.2 mm. The correlation, therefore, between 

 the carbon-dioxide tension, the alveolar air, the total metabolism and the 

 acidosis is clearly shown. 



Blood examination. The blood was examined daily and the results are 

 reported in table 141. 



Table 141. Results of blood examinations 1 Subject H. H. A. 



On Dec. 28 a stained specimen of the blood was examined microscopically with the following result: Differ- 

 ential count of 200 white blood-corpuscles showed polynuclear leucocytes 82.5 per cent, lymphocytes 

 15.5 per cent, transitionals 1 per cent.eosinophiles 1 percent. The red blood-corpuscles showed nothing 

 abnormal. 



It will be seen that the hemoglobin was constant for the four days; the 

 number of red blood- corpuscles was also essentially constant. We are unable 

 to explain the increase in the number of white blood-corpuscles on the first 

 afternoon after the first carbohydrate-free meal. The slight decrease in the 

 white blood-corpuscles found for the following successive days does not warrant 

 conclusions, particularly without support from similar experiments. 



The differential count of the white blood-corpuscles shows nothing 

 abnormal. 



RELATIONS BETWEEN A NORMALLY INDUCED ACIDOSIS AND THE OBSERVED 

 INCREASE IN THE METABOLISM IN SEVERE DIABETES. 



With both of these subjects there was a noticeable increase in the total 

 metabolism as measured by the oxygen consumption, coincident with the use 

 of a carbohydrate-free diet. With one case at least there was a corresponding 

 increase in the pulse-rate, while with the other there was a temporary increase 

 in the pulse-rate, followed by a decline. Since it is probable that an intimate 

 relationship exists between the blood-pressure and the pulse-rate, we have every 

 reason to believe that if all the data had been available this seeming discrep- 

 ancy between the results with the two subjects could be readily explained. 



If the presence of the small amount of /3-oxybutyric acid found with these 

 subjects was sufficient to stimulate the metabolism so that the metabolic 

 activity of the body itself as a whole was increased by the amount here found, 

 it is not at all surprising that in severe diabetes the same processes which 

 involved the formation and circulation of /3-oxybutyric acid molecules would 

 likewise tend to stimulate the body activity of the diabetic. On the other 

 hand, the constant presence of /3-oxybutyric acid throughout a long period of 

 time during the course of the disease might easily lead to an acquired tolerance 

 for the presence of /3-oxybutyric acid which would involve the necessity for the 



