416 RETROGRESSIVE CHANGES 



mental pancreatic diabetes may be accompanied by lipemia.^^ In- 

 creases in the blood lipoids, not usually of sufficient magnitude to cause 

 a distinct lipemia, may be found in nephritis (Bloor), cirrhosis, tabes 

 and paralysis (Feigl).^^ 



Neisser and Derlin^^ found 19.7 per cent, of fat in the blood of a 

 patient with diabetic coma (after death 24.4 per cent, was found) 

 whose urine contained 0.8 per cent, of fat, and through analysis of 

 this and other material came to the conclusion that the fat comes 

 directly from the chyle; i. e., that it is food fat, not body fat. Fischer 

 found an average of 18.129 per cent, in his case, including at least 

 0.478 per cent, of cholesterol, with no lipuria and very small amounts 

 of fatty acids; of the fat, about 67.5 per cent, was olein. Ringer®^ 

 has found 14.4 per cent, of lipins, including 2.14 per cent, of cholesterol. 

 As high as 27 per cent, of fat has been found in the blood.''" In many 

 cases the increase is chiefly in the lipoids, liyoidemia,"^^ and in acidosis 

 there is said to be an especial increase in cholesterol i^Adler).''^ 



Study of a large number of diabetic bloods by Gray'^^ gave the 

 following results: Normal lipin values are seldom found, the most 

 marked increases being in the total glycerides, next the total fatty 

 acids, then the cholesterol, and least the phospholipins. Increase of 

 both cholesterol and glycerides seems to be pathognomonic of chronic 

 diabetic lipemia, as in alimentary hpemia the increase is in the fatty 

 acids. The greater the duration of the diabetes the lower the lipins, 

 and high figures give a bad prognosis, being usually associated with 

 acidosis. Hyperglycemia and hyperlipemia do not run parallel.^* 

 In general, the amount of blood lipins increases with the severity of the 

 disease, ^^ the averages in a large series of analyses being as follows: 

 normal, 0.59 per cent.; mild diabetes, 0.83; moderate, 0.91; severe, 1.41. 

 The changes concern chiefly the plasma. Coexistent nephritis does 

 not modify the blood hpin figures. When the lipemia is accompanied 

 by icterus the fats may clear up and a clear serum is present, despite 

 a high fat content. ^"^ 



It is an important question whether, with high quantities of fat 

 in the blood, fat embolism may result, for it is possible that at least 

 some of the cases of diabetic coma are due to such fat embolism in 

 the cerebral vessels. Ebstein^^ considers this a possible, but not a 

 common, occurrence, because the droplets are too small to cause oc- 



" Seo, Arch. exp. Path. u. Pharm., 1909 (Gl), 1. 



" Biochem. Zeit., 1918 (88), 53; (90), 1. 



«» Zeit. klin. Med., 1904 (51), 428. 



"o Proc. Soc. Exp. Biol. Med., 1917 (15), 40. 



^» Frugoni and Marchetti, Bed. klin. Woch., 1908 (45), 1844. 



^1 See Weil, Munch, med. Woch., 1912 (59), 2096. 



" Berl. klin. Woch., 1910 (47), 1323. 



" Boston Med. Surg. Jour., 1917 (178), 16. 



'* Corroborated by Bang, Biochem. Zeit., 1919 (94), 359. 



" See Jour. Amer. Med. Assoc, 1917 (69), 375. 



'8 Feigl and Querner, Zeit. exp. Med., 1919 (9), 153. 



" Virchow's Arch., 1899 (155), 571. 



