442 ACETONE BODIES 



requires comparatively large amounts, which the patient 

 often can scarcely master . . . fifteen to one hundred, 

 up to two hundred grams or more, of sodium bicarbonate 

 may be necessary to accomplish the desired end. ... I 

 have never seen any more effect from intravenous adminis- 

 tration of alkali (usually given in the form of three or four 

 per cent, soda solutions) than from subcutaneous infiltrations 

 of isotonic sodium chloride solutions ; and for this reason, 

 like Naunyn, I have long ago given up the former method. 

 There is no question as to our ability to save severe cases 

 of diabetes by alkaline treatment in the face of an acidosis of 

 years ' duration, although without this method of treatment 

 this would be a matter of impossibility. When coma is fully 

 developed in adults all effort to stop it is in vain; but in 

 children now and then therapeutic results may be 

 obtained. 26 



C. v. Noorden 27 is in the habit of saying of these influ- 

 sions, because of his own rich experience, that any one who 

 has ever witnessed a single time the wonderful result pro- 

 duced by the infusion of a soda solution upon a comatose 

 diabetic subject is bound to accept as a certainty the effec- 

 tiveness of the alkaline treatment. Time and again the 

 patient is seen waking up from the deepest coma while the 

 infusion is being administered. There is no other agency 

 which will do the same thing. 



Antiketogenic Substances. In view of the antiketogenic 

 influence of carbohydrates, one should seek in those cases in 

 which acidosis arises after the withdrawal of carbohydrates 

 to give some form of these substances adapted to the diabetic 

 patient. In Umber's opinion these are the cases which 

 should be placed upon v. Noorden 's oatmeal treatment, by 

 which not infrequently it is possible to restore tolerance and 

 remove the impending danger of coma. 28 



36 F. Umber, Lehrbuch d. Ernahr. u. d. Stoffwechselkr., p. 231, 1909. 

 27 C. von Noorden, 1. c., p. 85. 

 F. Umber, I.e., p. 229. 



