566 ABNORMALITIES IN METABOLISM 



tory capacity may be able to maintain a normal acid threshhold 

 Begun and Miinzer^^" attribute part of the acidosis to a decreased 

 formation of NH3 in metabolism. 



Other Diseases with Acidosis. — While a slight degree of acidosis 

 undoubtedly may occur in many conditions, there are few conditions 

 in which it is of importance. Chief of these are the following: 



Asiatic Cholera exhibits often a severe acidosis, presumabh'- because of the 

 frequencj' of severe renal lesions (Sellards^'*). Loss of bases in the evacuations may 

 also be a factor. The acidosis differs from that of nephritis in the excretion of 

 large amounts of ammonia, but usually without acetone bodies. Other infectious 

 diseases do not commonly exhibit any significant degree of acidosis, rheumatic 

 fever alone excepted. 



Acidosis in infancy. — Both true acidosis and acetonuria, with or without 

 acidosis, occur frequently and easily in the young. Normalh' the urine of infants 

 and children contains about 3 mg. of acetone per kilo of body weight, and may be 

 increased to ten times that amount by fasting. ^^ Also the amount of acetone 

 bodies in the blood is greater and more readily increased by fasting than in adults. '^ 

 Presumably the infantile organism has a lower oxidative capacity, since it excretes 

 unoxidized organic acids from relatively slight causes, in corroboration of which is 

 the observation of Pfaundler^* that the proportion of nitrogen in the urine of 

 infants in forms other than urea is higher than in adults. However, according to 

 Howland and Marriott" serious acidosis in infancy and childhood, although 

 frequent, is usually not due to the acetone bodies. It is especially important in 

 severe choleriform diarrhea, possibly because of excretion of bases in the discharges, 

 and in burns and severe nephritis, acidosis is of significance. In ileocolitis true 

 acetonemic acidosis has been observed. 



Terminal Acidosis. — In many dying persons the final symptomatology is 

 strikingly like that of death from acidosis, and Wliitney has found that the final 

 figures for alkali reserve in the blood of animals killed by acid intoxication are of 

 the same order as those that may sometimes be obtained from dying patients ^^^th 

 many different diseases. Of forty cases studied by him, in all but three there was 

 marked acidosis, and in many there was a degree of acidosis sufficient of itself to 

 cause death. Sellards notes typical acidosis in advanced atrophic cirrhosis, but this 

 has not yet been sufficiently studied to permit of proper interpretation. Whenever 

 the blood pressure becomes greatly lowered, as in shock, there may occur an actual 

 acidosis. 



Severe anemia, both primary and secondarj^, may exliibit a moderated degree of 

 acidosis, but in only about one fifth of all cases examined by Sellards. 



Alkalosis 



The occurrence of an increase in OH ions of the blood, or of an 

 abnormally high alkali reserve and increased capacity to carry CO2, 

 seems to occur infrequently, presumably since the trend of metabolic 

 processes is to produce acid substances. The chief example is 

 furnished in tetany, whether the result of parathyroid insufficiency or 

 pyloric obstruction;^^ in the latter case excretion of acid which does 

 not enter the intestine to be neutralized might account for an excess 



»'« Zeit. exp. Path., 1919 (20), 78. 



»2 Veederand Johnstone, Amer. Jour. Dis. Child., 1917 (13), 89. 



" See Moore, ibid., 1916 (12), 244. The statement that there is usually a 

 relative acidosis in newborn infants could not be corroborated by Seham, ibid. 

 1919 (18), 42. 



" Jahrb. f. ICinderheilk., 1901 (54), 247. 



" Amer. Jour. Dis. Child., 191G (12), 459. 



«« See Wilson et al., Jour. Biol. Chem., 1915 (21), 169; 1915 (23), 89; McCann, 

 ibid., 1918 (35), 553. 



