558 AIi\ORMALITli:s I\ METAliOIAHM 



made completely diabetic Avith phlorliizin, and that lactic acid in- 

 jected subcutaneoiisly into a phlorliizinized animal is excreted gram 

 for o-ram as sugar. 



Not infrequently acetone and diacetic acid, less often oxybutyric 

 acid, are found in the urine of patients suffering from the most di- 

 verse diseases. It is customary to refer to this condition as " aceto- 

 tieniia" or "acetomiria," and to ascribe many of the observed symp- 

 toms to "acid intoxication." The presence of these substances in the 

 urine, however, is by no means evidence of acidosis, for excretion of 

 considerable amounts of acetone bodies may occur Avithout reduced 

 COg-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. g., acid phosphate retention in nephritis, or loss of bases from biliary 

 or pancreatic fistula. In no other condition 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 na- 

 tures. 



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

 Brewer and by Helen Baldwin,^" acetone is nearly always present in 

 the urine during the first twenty-four hours after administration of 

 either chloroform or ether, and occasionally diacetic acid appears on 

 the second or third day after; but ordinarily there is no increase in 

 organic acids in the urine. The starvation preceding and following 

 the operation is also a factor of considerable importance. It does not 

 seem probable that the symptoms observed in typical cases of delayed 

 chloroform-poisoning are due chiefly, if at all, to acid intoxication 

 per se, but rather are the result of extensive injury to the parenchy- 

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

 a condition resembling acute yellow atrophy or phosphorus-poison- 

 ing.^^ 



Cachectic Acetonuria. — Acetone and diacetic acid, but less abun- 

 dantly the oxybutyric acid, are found in the urine in many condi- 

 tions associated with wasting, among Avhich may be especially men- 

 tioned : 



Infantile marasmus,"- in which increased ammonia is found in the 

 urine, and sometimes sym])toms resembling acid intoxications occur. 

 Normally the urine of suckling infants contains 1-4 mg. per day of 

 acetone bodies, which may be increased to 15-35 mg. by simple hun- 

 ger. In fact, "acidosis" seems to occur particularly frequently in 

 infants from relatively slight causes, such as gastro-enteritis and 



■in .I.Hir. .,f T^iol. Choni., lOOG (1), 239. 



•"'i Wells, .lour. Amcr. ]\lcd. Assoc. l!)(l)i ()('.]. :M1. 



52 See Meyer and Laii{i;stein. .Jalirb. f Isiiidrrhcilk.. 1!M)(1 (fi.T). .10. 



