\()\-I)/\I!i:tic Ac/n nrox/r \'ni)\ 559 



other infectious conditions. 'J'liis is perliaps due to a lower oxidizing 

 power on the part of the infantile organism ( Pfaundler),''^ since 

 the proportion of nitrogen in the urine of infants in forms other 

 than urea, is higher than in adults. Even an unusually fatty diet 

 may cause aeetonuria in infants. It has also been suggested that ex- 

 cessive formation of acids in the intestine through bactei-ial decompo- 

 sition may cause withdrawal of tlic bases from tlic IjIooiI. wliich are 

 lost to tlie body through excretion in the feces. 



Starvation. — Acetone, which is normally excreted through the 

 lungs for tlie most part (80-90 per cent, of that produced) appears 

 in excess in the urine verj' soon after fasting begins, there being 

 more produced than can be exhaled. After 24 to 36 hours of fasting, 

 diacetic acid appears, and then oxybutyric acid, which may reach 10 

 to 20 grams per day in starvation, and even higher figures are re- 

 corded. The urinary ammonia nitrogen runs parallel to the acidosis. 

 The use of a carbohydrate-free diet is also accompanied by a marked 

 acetonuria,^^'' no matter how much fat is supplied, which may reach a 

 point where several grams of oxybutyric acid are being excreted per 

 day without symptoms of serious intoxication. A relatively small 

 amount of carbohydrate (80 grams) is sufficient to prevent this 

 acidosis. If the meat-fat diet is continued for some time, however, 

 there seems to be some sort of adaptation so that the aeetonuria di- 

 minishes until practically normal figures may be reached. 



Acidosis of Pre^ancy. — During pregnancy the urine usually con- 

 tains acetone in slight excess, and occasionally is in large excess in 

 women who are suffering from the toxemias of pregnancy. Here 

 there is a rise in ammonia far beyond the proportion of acetone bod- 

 ies, partly because of the large amounfs of lactic acid which are ex- 

 creted, and partly from abnormal protein metabolism and tissue de- 

 struction, but the proportion of the urinarv^ nitrogen which is consti- 

 tuted by ammonia is too inconstant to serve as a prognostic and 

 operative guide. Ewing has observed a case of pernicious vomiting 

 with 75 per cent, of the total nitrogen as ammonia, and no urea, — 

 while there may occur fatal cases without large excess of ammonia. 

 Higher ammonia figures are usually reached in pernicious vomiting of 

 pregnancy than in eclampsia ; in neither is the acidosis present suffi- 

 cient to account for the intoxication. (See discussion of "Eclamp- 

 sia.") Even normal pregnant women seem to show a reduced ability 

 to tolerate a deficiency in the carbohydrates of the diet.^* 



Cyclic Vomiting. — Here the urine usually shows acetone bodies, lac- 

 tic acid, indican in excess, and a rise in the proportion of neutral 

 to oxidized sulphur (Howland and Richards). As these findings 

 may persist in spite of absorption of carbohydrates, they are not en- 



33,Jahrb. f. Kinderheilk.. 1001 (.54), 247. 



53a See Higgins. Peabodv and Fit/. Jour. ^Fed. T!os.. 1910 (.341, 203. 



54Porges and Novak, Berl. klin. Woch., 1911 (4S), I7")7. 



