ACIDOSIS 89 



acids, nor did Van Slyke and Palmer (1020) in comparing the excretion 

 of the acetone bodies with that of the total organic acids. 



Diagnosis of Acidosis in Diabetes. In diabetes acidosis may be ex- 

 cluded by a qualitative test for acetone bodies in the urine, since they 

 appear never to markedly affect the internal acid-base balance, without 

 appearing in the urine in sufficient amount to be readily recognized. If 

 acetone bodies appear, however, it is impossible to tell, even when their 

 concentration in the urine is maximal, whether they are causing alkali 

 deficit or not, and one of the direct measures of the alkali reserve (blood 

 BHCO 3 estimation or bicarbonate retention test) is required, with func- 

 tional tests, alveolar CO 2 or the rate of acid plus ammonia excretion, as 

 somewhat less accurate alternatives. . 



In determining the acid-base balance in the blood in diabetic acidosis, 

 it appears that for ordinary diagnostic purposes, a bicarbonate determina- 

 tion without the pH is sufficient. Unless unusual complications are pres- 

 ent the respiratory mechanism appears to be fairly normal, and the two 

 conditions encountered are either compensated alkali deficit (Area 6, 

 Fig. II) with low BHCO 3 and normal pH, or, in terminal coma, un- 

 compensated alkali deficit. In the latter the pH is lowered, but the 

 BHCO 3 is also greatly lowered. 



Therapy. The therapy in diabetic acidosis depends so entirely on the 

 condition cf the individual patient that an attempt to treat the condition 

 according to a uniform rule would be unnecessarily disastrous in a con- 

 siderable percentage of the cases so treated. A definite procedure for guid- 

 ing the treatment by the plasma bicarbonate and the clinical condition of 

 the patient has, however, been laid down on the basis of experience by 

 Stillman (1919), and the reader is referred to his publication. The 

 treatment in outline consists of a fast, with abundant fluids, accompanied, 

 if the plasma bicarbonate CO 2 is below 30 volumes per cent, by bicarbonate 

 given by mouth at the rate of 3 grams per hour. If the plasma bicar- 

 bonate falls during the fast, as occurs in occasional cases, a moderate diet 

 consisting chiefly of protein (meat and eggs) is given, with a later re- 

 sumption of fasting to render the patient aglycosuric. After the aglyco- 

 suric condition is obtained, the fast is broken by giving a gradually in- 

 creasing diet of green vegetables. A logical basis for estimating the 

 amount of fat, carbohydrate, and protein consumed in such proportions 

 that ketone formation is avoided has recently been proposed by Shaffer 

 (1921) and Woodyatt (1921). 



Nephritis. Type and Cause of Acidosis. That acid intoxication oc- 

 curs in nephritis was shown by Jaksch(/) (1887). Straub and Schlayer 

 (1912) have given evidence that acid intoxication is a cause of uremic 

 coma, an explanation which is well supported by the fact that a patient 

 in uremic coma can be brought out of it by bicarbonate injection. Chace 



