ACETONURIA 567 



of bases in the blood. Tetany is improved by giving acids, and pre- 

 sumably the convulsions of the disease have a similar (ifTcct through 

 increased acid production. IVIenten^^ has found an increased OII- 

 ion concentration in the blood to be characteristic of cancer, whether 

 involving the stomach or not, although sometimes observed in other 

 conditions, especially diabetes before the stage of acidosis. A slight 

 degree of alkalosis may be produced by feeding large amounts of 

 alkali, in which case some of the alkah is removed in the urine com- 

 bined with lactic acid.^"^ 



ACETONURIA WITHOUT MARKED ACIDOSIS 



Not infrequently acetone bodies are found in the urine of patients 

 suffering from the most diverse diseases. It is customary to refer 

 to this condition as '^acetonemia" or " acetonuria," and to ascribe 

 many of the observed symptoms to "acid intoxication." The pres- 

 ence of these substances in the urine, however, is by no means evidence 

 of acidosis, for excretion of considerable amounts of acetone bodies 

 may occur without reduced COa-carrying capacity of the blood and 

 they may be absent with marked acidosis. In addition, it must be 

 kept in mind that acidosis may result from other causes than over- 

 production of organic acids; e.gr., acid phosphate retention in nephritis, 

 or loss of bases from biliary or pancreatic fistula. In no other condi- 

 tions do the amounts of organic acids in the urine approximate the 

 amounts found in diabetic coma. Therefore, the intoxication in 

 these cases is probably not due to the acids, but, on the contrary, the 

 presence of the acetone bodies is due more often to the effects of toxic 

 substances of diverse origins and natures. 



Anesthesia. — As shown first by Greven (1895), and especially by Brewer and 

 Helen Baldwin^^ acetone is nearly always present in the urine during the first 

 twenty-four hours after administration of chloroform or ether, and occasionally 

 diacetic acid appears on the second or third daj' after; but ordinarily there is no 

 increase in organic acids in the urine. There is usually little or no demonstrable 

 acidosis.^ The starvation preceding and following the operation is also a factor 

 of considerable importance. It does not seem probable that the s.\ mptoms 

 observed in typical cases of delayed chloroform-poisoning {q. v.) are due chiefly, 

 if at all, to acid intoxication per se, but rather are the result of extensive injury to 

 the parenchymatous organs, particularly the liver, by the chloroform, which causes 

 a condition resembling acute yellow atrophy or phosphorus-poisoning. 



Cachectic Acetonuria. — Acetone and diacetic acid, but less abundantly the 

 oxybutyric acid are found in the urine in many conditions associated with wasting, 

 among which may be especially mentioned : 



Starvation. — -Acetone, which is normalh* excreted through the lungs for the 

 most part (80-90 per cent, of that produced) appears in excess in the urine very 

 soon after fasting begins, there being more produced than can be exhaled. It is 

 associated \\'ith diacetic acid and oxybutyric acid, which may reach 10 to 20 grams 

 per day in starvation, and even higher figures are recorded. The urinary ammonia 

 nitrogen runs parallel to the acid excretion. The use of a carbohydrate free 



«" Jour. Cancer Res., 1917 (2) 179. 



'* Macleod and Knapp, Amer. Jour. Physiol., 1918 (47), 189. 

 S3 .Jour, of Biol. Chem., 190t) (1), 239. 

 1 See Caldwell and Cleveland, Surg. Gyn. Obst., 1917 (25), 22. 



