800 W. McKIM MAKKIOTT 



not formed in the normal manner so that ammonium salts appear instead 

 of urea in the urine. It is much more likely that the high ammonia of 

 the urine is due to the fact that there is an excessive excretion of organic 

 acids (Utheim(6) ) ; the nature and mode of origin of these acids is as yet 

 unknown. 



Fat metabolism is usually affected in the condition of athrepsia es- 

 pecially during periods of diarrhea. Absorption cf fat is poorer than in 

 normal infants and considerable amounts of neutral fat, soaps or free 

 fatty acids may appear in the stools (L. F. Meyer (d) ). The loss of fat in 

 this way results in just so much less caloric intake and favors the further 

 breaking down of body tissue to supply the energy demands. It has 

 been shown by Marriott and Sisson that the amount of fat circulating 

 in the blood of infants in the condition of athrepsia is low in those in- 

 fants whose weight is stationary or who are losing, but is distinctly in- 

 creased in those who are showing satisfactory weight gains. This is prob- 

 ably evidence of increased absorption of fat in the infants who are con- 

 valescing from the condition. 



Carbohydrates fed to athreptic infants seem to be well absorbed 

 except when given in sufficient amounts to cause diarrhea, in which con- 

 dition there may be considerable amounts of lower fatty acids in the 

 stools, these fatty acids being the result of bacterial fermentation of sugar 

 and representing a loss of food material from the body. Sugar itself 

 rarely occurs in the stools except in very severe diarrhea. Starch may, 

 however, occur in considerable amounts when the infant is receiving 

 starch-containing foods. Athreptic infants have the capacity for 

 utilizing very large amounts of carbohydrates when introduced paren- 

 terally. The amount which can be administered without leading to 

 glycosuria is very high per kilo of body weight as compared with normal 

 infants or adults (Ilelmholz and Saner, Porter and Dunn). 



The basal energy metabolism of athreptic infants is often high as 

 compared with those who are normal. Bahrdt and Edelstein(c) found the 

 total energy exchange of an athreptic infant to be 1711 calories per square 

 meter (Lissauer's formula), an amount about 50 per cent greater than 

 normal. Frank and Wolf observed a basal metabolism of 123 calories per 

 kilo (normal about 65 calories per kilo) in an athreptic infant. In 

 this same infant the food intake represented not over 108 calories per 

 kilo. It is very easy to see why such an infant is compelled to utilize 

 body tissue as food. As a cause of this greatly increased metabolism 

 Frank and Wolf suggest an overactivity of the digestive glands in re- 

 sponse to some stimulus in the gastro-intestinal tract. They do not, how- 

 ever, prove the correctness of this assumption. Similar high figures for 

 the basal metabolism were obtained by Nieinann(d) and by Kubner and 

 Heubner. 



The condition of athrepsia which has just been considered although 



