ij/'inuA 413 



l)ody fat. Fisclier 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. As higii as 27 per cent, of fat in the blood has been found."'- In 

 many cases the increase is chiefly in tlie lipoids, lipoidemia,^^ and in 

 acidosis there is said to be an especial increase in cholesterol (Adler).^* 



It is an important question whetlier, witli such high (luantities of fat 

 in the blood, fat embolism ma}' 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- 

 clusion of the vessels unless they combine to form large droplets. 

 Fischer doubts if the droplets ever fuse together enough to cause em- 

 bolism, supporting his contention both by experiments and clinical 

 records, but cases have been reported as fat embolism from diabetic 

 lipemia.''^ 



The cause of lipemia has not yet been satisfactorily determined. In 

 alcoholism it is commonly ascribed to a failure to burn fat, because 

 of the presence of the more readily oxidized alcohol, and the common 

 coexistence of diabetes and lipemia suggests for both a common cause ; 

 i. e., lack of oxidation of fat and sugar. In corroboration may be 

 cited the occurrence of lipemia in other conditions associated with 

 defective oxidation ; /. e., pneumonia, anemia,^** phosphorus-poisoning. 

 As we are still unfamiliar with the essential factors and steps in the 

 oxidation of fat, it would be mere speculation to attempt to explain 

 further the reason for the failure of destruction of the fat. The 

 origin of the fat in lipemia is likewise undetermined. Ebstein con- 

 siders that it arises partly from the food, partly from fattj' degenera- 

 tion of the cells of the blood, the vessel-walls, and the viscera. Neisser 

 and Berlin consider it as merely food fat coming from the chyle and 

 accumulated in the blood. Fischer believes that it is largely derived 

 from the fat depots, and that because of loss of the lipolytic power 

 of the blood it cannot be rendered diffusible, and hence it cannot enter 

 the tissues where it is normally consumed. Sakai ^"'^ also found a low 

 lipase content in the blood and suggests that fat entering the blood is 

 unable to leave it because of defective lipolysis. Klemperer and Um- 

 ber hold that it comes from disintegration of tissue cells, but are 

 unable to determine the cells concerned. 



Bloor's studies^"" support strongly the view that the fats come 



52 Frugoni and ^ilarchetti, Berl. klin. Woch., 1908 (4.")), 1S44. 



53 See Weil, IMiineh. med. Woch., 1012 (59), 2096. 

 ■'•••iBerl. klin. Woch., 1910 (47), 132.3. 



53 Virchow's Arch., 1899 (1.55), 571. 

 51 Hedren, Svenska Liik. Handl., 1910 (42), 933. 



56 See Boggs and Morris (Jour. Exper. Med., 1909 (11), 553), wiio produced 

 lipemia bv repeatedly l)leeding rabbits. 

 ssaBioo'hem. Zeit.,'l914 (62). 387. 

 56b Jour. Biol. Chem., 1916 (26), 417. 



