140 III. OXIDATION AND METABOLISM 



able ill the case of the professional faster, Levanzin, who was studied by 

 Benedict ;^*^ the latter subject excreted 5.0 g. of (S-hydroxybutyrate on the 

 twenty-first day, and 4.5 g. on the thirty-first fast day. 



(6) The Ingestion of a Protein-Fat Diet. Ketonuria occurs in human sub- 

 jects maintained on a protein-fat diet largely devoid of carbohydrate. 

 McClellan and DuBois^^^ and Tolstoi^'*^ reported that ketonuria occurred 

 continuously in the case of two Arctic explorers who were on a protein-fat 

 diet over the course of a year. Deuel et al.^^^ showed that the level of 

 ketonuria was maintained on a similar diet for as long as twenty-seven days. 

 The acetone-body excretion of one subject in g. for the days on the protein- 

 fat diet were as follows: 1, 0.14; 2, 1.01; S, 1.10; 4, 2.50; 5, 2.71 

 6, 4.89; 7, 6.41; 8, 5.17; 9, 8.23; 10, 6.21; 11, 5.30; 12, 6.31; 13, 7.05 

 IJ^, 6.62; 15, 5.26; 16, 5.73 (25 g. glucose taken on this day); 17, 4.45 

 18, 5.91; and 19, 5.70. The maximum values correspond almost exactly 

 to those for the same subject during a complete fast, which were as follows, 

 expressed in g.: 0, 0.64; 1, 0.30; 2, 5.17; S, 7.28, Jf, 8.95, 5, 6.64, 6, 

 9.52; and 7, 7.60. However, the maximum level of ketonuria was reached 

 more slowly on the protein-fat regimen than during starvation. 



(c) Diabetes Mellitus. Prior to the advent of insulin, marked ketosis 

 was an invariable concomitant of diabetes melHtus. Frequently, the 

 extreme acidosis so engendered was partially responsible for the fatal out- 

 come of this disease. For example, the ketonuria (/^-hj^droxybutyrate) 

 of a patient reported by Mosenthal and Lewis^^^ for a period shortly before 

 death was as follows (expressed in g.) : Day 1, 04.9; Day 2, 66.0; Day S, 

 50.6; Day 4, 64.9; Day 5, 78.0; Day ^,111.2; Day 7, 106.6; and Day 5, 

 73.0. The patient died on the second day after the last determination of 

 ketonuria. The subject refused food during this period, receiving largely 

 alcoholic beverages. One factor which may have contributed to the high 

 ketonuria was the fact that NaHCOs was administered at a high level. 



In another case of severe diabetes melHtus in the pre-insulin era, which 

 was studied by Geyelin and DuBois,^^^ the high ketonuria decreased with 

 chnical improvement. Thus, the subject, Cyril K., presented (8-hydroxy- 

 butyrate values on thirteen days as follows: 43.7, 34.6, 60.0, 53.0, 57.9, 

 55.2, 70.8, 75.1, 87.4, 58.5, 56.8, and 41.2 g. As the symptoms cleared up, 

 the ketonuria decreased to 26.2 g. on the fourteenth day, and to 10.95 g. on 



'*' F. G. Benedict, A Study of Prolonged Fasting, Carnegie Inst., Washington, Puhl. 

 No. 203, 5-416, 1915, p. 283. 



348 W. S. McClellan and E. F. DuBois, /. Biol. Chem., 87, 651-668 (1930). 



3« E. Tolstoi, /. Biol. Chem., 83, 753-758 (1929). 



360 H. J. Deuel, Jr., M. Gulick, and J. S. Butts, /. Biol. Chem., 98, 333-351 (1932). 



=" H. O. Mosenthal and D. S. Lewis, Bnll. .Johns Hopkins Hosp., 28, 187-191 (1917). 



