560 ABNORMALITIES IX METABOLISM 



tirely due to starvation, and there are severe fatty changes in the 

 liver and kidneys, indicating a toxemic origin associated with de- 

 fective oxidation. ^Iclhinl)y ■'"' fuuntl a considerable creatine elimina- 

 tion in a typical case, together with the acidosis. 



Inanition and Cachexia^ — Under this heading may be grouped the 

 acetonuria observed in intestinal disturbances in children,'^^'^ hys- 

 terical vomiting, psychoses, and cancer. In each of these conditions 

 coma of the type of diabetic coma has sometimes been observed, and 

 in all of them acetonuria is common, the reasons being obvious after 

 the above discussion. A relative acidosis may also result from de- 

 ficiency of bases in the diet of growing infants. In many cases of 

 acidosis of infants there is not sufficient increase in the acetone bodies 

 of the blood to account for the acidosis ; "'^ on the other hand, most of 

 the children excreting acetone bodies in the urine do not have acidosis. 



Retention of placenta or fetus, acetonuria being considered of di- 

 agnostic value in determining the death of the fetus in utero,^'' but 

 not in extrauterine pregnancy (Wechsberg).-'* 



In uremia, as previously mentioned, organic acids may appear in 

 the urine, but apparently as a result, and not as the cause, of the 

 uremia (Orlowski). There is usually some acidosis in advanced 

 nephritis, but marked only in uremia. ^*^ Here, according to ]\Iarriott 

 and Howland,^^'' acid phosphates which the kidney has failed to ex- 

 crete, may be an important factor. Sometimes in advanced nephritis 

 the acidosis may be of such a degree as to simulate diabetic coma, and 

 the nocturnal hyperopnoea of nephritis probablj" is the result of 

 acidosis (Whitney-^). 



Other Conditions. — Acetonuria is observed inconstantly in fever, 

 especially in children; also after poisoning by many drugs, includ- 

 ing, besides the heavy metals, morphine, atropine, antipyrine, and 

 phlorhizin. Asiatic cholera shows a marked acidosis, in manj^ re- 

 spects resembling diabetic acidosis,'**'^ and gastro-intestinal infections 

 of similar sorts may cause severe acetonuria. "Whitney -^ finds acid- 

 osis to be a common terminal event in many diseases, and often the 

 immediate cause of death. Pneumonia is accompanied by acidosis,^*^ 

 often of serious degree, subsiding rapidly after the crisis. At high 

 altitudes there is always an acidosis, which stimulates the respiratory 

 center to increased activity. In asphyxial conditions of all sorts 



S5 Lant'ot, Jiilv 1, UMl. 



55a See Ilowland and .Marriott, Amer. Jour. Dis. Child.. lOlC, (11), ,?0!) : (12), 

 459. 



■">'! Moore, Amcr. .Tour. Dis. Cliild., miC, (12), 244. 



57 See Frojumer. Borl. Ulin. Woch., 100;! (42), 1008. 



ssWien. klin. Wocli., 1000 (10), 053. 



r.'^aSee Scllards, Hull. Jolins Hopkins Hosp., 1014 (2.")). 141: Toabodv, Arch. 

 Int. :Med., 1015 (10), 455. 



58i> Arcli. Int. :M('d., lOlG (IS), 70S. 



f'Sc Sellards and Sluikloo. Pliilipi)ine Jour. Sci., 1011 (G), 53. 



50 Lewis and Barcroft, Quart. Jour. Med.. l!)15 (S), lOS. 



