724: FRANCIS H. McORUDDEN 



nection between carbohydrate metabolism and creatinuria is so close that, 

 when we find creatin in the urine of a man, we suspect something abnormal 

 in the carbohydrate metabolism; we suspect that glucose is not being 

 oxidized in sufficient quantities. 



The urinary creatinin was very low in all the cases reported by Janney, 

 Goodhart, and Isaacson, and Gibson, Martin and Buell, but not in those 

 reported by McCrudden. The decreased excretion of creatinin is not 

 particularly significant. The amount of urinary creatinin is an indica- 

 tion of the muscular efficiency of the patient (Shaffer (a)). A low 

 urinary creatinin is found in other conditions accompanied by muscular 

 asthenia, and in progressive muscular dystrophy is probably secondary to 

 the myasthenia. 



A Ikalosis. The possibility that alkalosis plays a part in the etiology of 

 progressive muscular dystrophy was suggested by the following facts con- 

 necting alkalosis, hypoglycemia, and creatinuria : 



(A) Alkalosis and Hypoglycemia. (a) Alkali administration causes 

 hypoglycemia ( Underbill (e) Elias) ; it diminishes and may even prevent 

 epinephrin-hyperglycemia and glycosuria (Elias, McDanell and Under- 

 hill(e)). 



(b) Acid administration increases glycogenolysis, causes hypergly- 

 cemia and augments epinephrin hyperglycemia (Elias). 



(c) The hypoglycemia induced by injection of guanidin hydrochlorid 

 is preceded by severe acidosis and the two are correlated (Watanabe(a) 



(d) If a frog be kept in a slightly acid solution, its store of glycogen 

 diminishes ; if in an alkaline solution, the glycogen store augments (Erh- 

 lich). 



(e) A base-forming diet is more efficient as a glycogen former 

 (McDanell and Underbill (d)) and gives a greater epinephrin glycosuria 

 (McDanell and Underbill (&)) than an acid-forming diet. 



(f) Epinephrin hyperglycemia is accompanied by a decrease (Peters 

 and Geyelin) and thyroparathyroidectomy hypoglycrmia by an increase 

 in the alkali reserve of the blood (Wilson, Stearns and Janney, Wilson, 

 Stearns and Thurlow). 



(B) Alkalosis and Creatinuria. (a) In rabbits creatinuria follows 

 administration of acid or an acid diet ( Underbill (e)) in which case the 

 urine is always acid (Underbill and Bogart). 



(b) Alkali administration diminishes, and sometimes abolishes the 

 creatinuria of starvation ( Underbill (d)). 



But alteration in the acid base equilibrium severe enough to produce 

 hypoglycemia leads to marked changes in the reaction of the urine (Mc- 

 Danell and Underbill (a)), and such changes are not present in progressive 

 muscular dystrophy. Ammonia excretion is normal, never higher than 

 0.43 gram per day in the cases reported by McOrudden and Sargent (&) 



