274 PHYSIOLOGICAL CHEMISTRY 



p. 273. The data there tabulated have been compiled from the work 

 of many observers. 1 



It will be noted that in chronic nephritis the principal change is in 

 the urea and non-protein nitrogen of the blood which may increase 

 considerably. In severe cases associated with uremia the retention of 

 these forms of nitrogen may be very great and there is a consequent 

 rise in the blood content which may amount to 1000 per cent or more. 

 In uremia there is likewise a great increase in other individual nitroge- 

 nous components of the blood such as uric acid, creatinine, creatine, 

 amino-acid nitrogen, and even of ammonia. The increase in creatinine 

 has been shown by Myers and Fine and others to be significant, inas- 

 much as this increase does not appear to occur in other types of nephritis. 

 Uric acid is greatly increased in uremia and may be very much higher 

 than in gout. Associated with uremia there is ordinarily an acidosis. 

 There may be an increase in the sugar of the blood and a very great 

 increase of the acetone bodies present. An increase is also generally 

 found in cholesterol and in the various forms of phosphorus of the blood, 

 while calcium may be decreased. 



Determinations of non-protein nitrogen and urea are also of great 

 value to the surgeon in determining the risk of operation, especially 

 in cases of prostatic obstruction. 



In diabetes the most noteworthy changes are in the content of glucose 

 and of acetone bodies. Glucose may be increased above the normal 

 (about o.i per cent) to 0.15-0.80 per cent. The increase in acetone, 

 diacetic acid and hydroxybutyric acid is very marked in comparison 

 with the minute amounts found in normal blood. There may also be 

 an increase in fat and other lipoids in severe diabetes. 



On the other hand in the condition known as renal diabetes glucose 

 is found in the urine without symptoms of diabetes mellitus and with a 

 normal blood sugar. 



In moderate acidosis the " alkali reserve" measured in terms of 

 carbon dioxide may range from 40 to 30 volumes per cent, whereas 

 values below 30 are met with in severe acidosis (see Chapter XVII) . 



In gout the characteristic change is in the uric acid content which is 

 almost always considerably increased. Other forms of nitrogen are 



1 The following may be particularly mentioned: Myers and Fine: Jour. Biol. Chem., 

 20, 391,- 1915; Post-Graduate, 1914-15; reprinted as "Chemical Composition of the Blood 

 in Health and Disease," New York, 1915; Folin and Denis: Jour. Biol. Chem., 14, 29, 

 1913; 13, 469, 1913; 17, 487, 1914; Arch. Int. Med., 16, 33, 1915; Christian, Frothingham 

 and Wood: Am. J. Med. Sci., 150, 655, 1915; Greenwald: Jour. Biol. Chem., 21, 29, 1915; 

 Van Slyke and Meyer: Jour. Biol. Chem., 12, 399, 1912; Bloor: Jour. Biol. Chem,, 23, 

 317, 1915; Marriott: Jour. Biol. Chem., 16, 293, 1913; 18, 507, 1914; Gettler and Baker: 

 Jour. Biol. Chem., 25, 211, 1916; Bock: Jour. Biol. Chem., 29, 191, 1917; Wilson and Plass: 

 Jour. Biol. Chem., 29, 413, 1917; Barnett: Jour. Biol. Chem., 29, 459, 1917; Hunter and 

 Campbell: Jour. Biol. Chem., 33, 169, 1918; Stillman, Van Slyke, Cullen and Fitz: Jour. 

 Biol. Chem., 30, 405, 1917. 



: Jour. 



