86 DONALD D. VAN SLYKE 



accurately the condition of the acid-base balance of the body, which may be 

 normal even when large amounts of acetone bodies are being excreted. 

 The daily excretion of the acetone bodies may be followed with sufficient 

 accuracy for most purposes, in diabetes at least, by means of the simple 

 organic acid titration method of Van Slyke and Palmer (1920). 



As a test for acidosis caused by the ketone bodies, qualitative de- 

 terminations of the acetone or acetoacetic acid in the urine are significant 

 so long as they are negative. A diabetic with no acetone in the urine 

 may be assumed to have a normal alkaline reserve. The appearance of 

 acetone bodies, however, is only -a sign of abnormal fatty acid combustion, 

 which may or may not lead to an alkali deficit. 



Diagnosis and Therapy in the More Frequent Types 



of Acidosis 



General Considerations Concerning Diagnosis. In a clinical condi- 

 tion that has not been studied completely enough to permit taking fov 

 granted any of the factors involved, the state of the acid-base balance 

 can be ascertained only by determining both the bicarbonate and the pH 

 of the blood. For example, lack of simultaneous determinations of both 

 factors leaves us at present uncertain as to whether the lowered plasma 

 bicarbonate observed by Cannon(a) (6) (1918) in traumatic shock indi- 

 cates a genuine deficit in the available alkali of the body (Areas 6 or 9, 

 Fig. II) caused primarily by retention of non-volatile acids, or whether 

 the condition is one of CO 2 deficit due primarily to hyperpnea (Area 3, 

 Fig. II) and leading not to acidification but to alkalinization of the body, 

 as believed by Y. Henderson and Haggard (d} (1918). 



If, however, it is established that the acidosis occurring in a given 

 clinical condition is always of one type (e. g., the ketosis of diabetes) the 

 test of patients in this condition may, with relatively small chance of error, 

 be reduced to the simplest technique that will reveal the type of acid-base 

 disturbance ordinarily encountered. Thus tests for acetone in the urine 

 are of value in excluding acidosis in diabetes, but useless in the marasmus 

 of infants. 



General Considerations Concerning Therapy. Acidosis is a by-product 

 of disordered metabolism. Measures against it, in order to be of more 

 than transitory benefit, must therefore correct the abnormal condition 

 from which the acidosis is a secondary result. 



Nevertheless it appears that the acidosis itself may at times, as in 

 threatened diabetic coma, become so acute that measures aimed at the im- 

 mediate, even though temporary, restoration of the acid-base balance are 

 indicated in order to prolong life. As such a measure the administration 



