FACTORS ALTERING CONCENTRATION OF BLOOD LIPIDS 451 



blood stream are present in higher percentages in the concentrated blood. 



The neutral fat fraction is increased to a greater degree than are the 

 other blood lipid fractions, in diabetic acidosis. Man and Peters 612 re- 

 ported that, following recovery from diabetic acidosis, lipid phosphorus, 

 cholesterol, and serum proteins showed a parallel decrease. The fatty 

 acids increased out of proportion to the phospholipids and cholesterol 

 during the active phase of the acidosis. The degree of increase of phos- 

 pholipids was somewhat greater than was that of cholesterol, so that the 

 cholesterol : lipid phosphorus ratio tended to fall below normal during the 

 diabetic acidosis. Harris et a/. 614 found that hemoconcentration plays an 

 important role in the production of hyperlipemia as a whole. However, 

 there is also an accession to the plasma of other lipids. This increment is 

 composed chiefly of neutral fat with lesser quantities of phospholipids, 

 free cholesterol, and cholesterol esters in descending order of magnitude. 

 These are all believed to be in a free state rather than in a protein combi- 

 nation. 



(d') Ketosis in Diabetes Mellitus. — As has been discussed in the previ- 

 ous section, one of the outstanding features of diabetes mellitus is the oc- 

 currence of the ketone bodies in the blood and urine. The intensity of 

 this ketosis varies with several factors. The most important is the occur- 

 rence of concomitant infections, which markedly increase the level of 

 blood ketone bodies. Another condition upon which the degree of ketosis 

 depends is the adequacy of the insulin therapy. When insulin injections 

 are omitted, or insufficient doses are administered, increased ketosis may 

 be anticipated. 



Allen et a 7 .. 598 cited a case of diabetic acidosis in which 368 milligram per 

 cent of ketones (calculated as acetone) were found in the blood. Magnus- 

 Levy 615 reported a case in which a boy eliminated 97.5 g. of ketone bodies 

 daily in the urine, over a period of three days. In several other instances 

 a ketonuria of 40 g. per day has been recorded. 615-617 The C0 2 -combii)ing 

 power of the blood, which is an excellent index of the severity of the acido- 

 sis, may reach as low a value as 10 volumes per cent, compared with a nor- 

 mal level of 55 to 60 volumes. 



The severity of the ketosis and ketonuria during fasting is much less, 

 for male subjects, than in severe diabetes. However, in the case of five 

 normal females who fasted, the maximum ketonurias noted on the third 



614 L. V. D. Harris, M. J. Albrink, W. F. Van Eck, E. B. Man, and J. P. Peters, 

 Metabolism, 2, 120-132 (1953). 



615 A. Magnus-Levy, Ergeb. inn. Med., 1, 352-419 (1908). 



616 A. Magnus-Levy, Johns Hopkins Hosp. Bull, 22, 46-53 (1911). 

 " 7 W. M. Marriott, /. Biol, Chem., 18, 507-517 (1914). 



