BODY TISSUES AND FLUIDS 449 



As pointed out above cholesterol constitutes an excellent index of the 

 degree of lipemia in diabetes. The decrease in this antihemolytic sub- 

 stance in the plasma in anemia would appear to be of considerable sig- 

 nificance. 



That cholesterol is partly present in the blood as an ester (fat) has 

 long been recognized. Bloor and Knudson have found that in whole blood 

 the average percentage of cholesterol in combination as esters is about 

 33.5 per cent, and in the plasma 58 per cent of the total cholesterol. 



Acetone Bodies 



Owing to the importance which the acetone bodies hold in the acidosis, 

 or more specifically the ketosis, occurring particularly in diabetes the 

 quantities of these substances acetone, aceto-acetic acid and fi-hydroxybu- 

 tyric acid present in normal and pathological human blood is of consid- 

 erable interest. Quite recently methods have been described by Marriott, 

 (a) and by Van Slyke and Fitz for their estimation in blood. Since acetone 

 is very diffusible it is natural to expect that it should be fairly evenly dis- 

 tributed in the various body fluids, such as the blood and spinal fluid. The 

 concentration in the urine, .however, is considerably greater than that in 

 the blood. The amount of the (3-hydroxybutyric acid present in both blood 

 and urine is ordinarily in excess of the combined acetone-aceto-acetic acid 

 fraction, often exceeding the latter by two or three times. 



According to Van Slyke and Fitz the total acetone bodies of the blood 

 normally amount to 1.3 to 2.6 mg. to 100 c.c. calculated as acetone, while 

 in diabetes as much as 350 mg. have been observed, although patients 

 under ordinarily good control show 10 to 40 mg. Allen, Stillman and 

 Fitz state that there appears to be 110 constant relation between the plas- 

 ma alkali and the plasma acetone in diabetes. The acetone bodies may 

 rise greatly even after the carbon dioxid combining power of the blood 

 has been considerably raised by the administration of alkali, and death 

 ensue. The acetone bodies in the blood of children have been studied by 

 Moore. He found in a fairly large series of normal children, that the 

 acetone plus aceto-acetic acid calculated as acetone averages 2.4 mg. to 

 100 c.c., while the |3-hydroxybutyric acid as acetone amounted to 3.9 mg., 

 a total of 6.3 mg. In one case of ileocolitis with acetonuria the total 

 acetone bodies rose to 183 mg. per 100 c.c. shortly before death. Moore 

 states that in a few cases showing acidosis clinically, the acetone of the 

 blood has been found sufficient to account for the acidosis. From a study 

 of the acetone bodies of the blood following ether anesthesia Short con- 

 cludes that the acetone bodies are not formed promptly enough to account 

 for the decreased plasma bicarbonate. 



