758 URINE. 



tioned, and the reader is referred to Chapters VIII and IX for the essential 

 facts in regard to the appearance of sugar in the urine. 



In man the appearance of dextrose in the urine has been observed 

 under various pathological conditions, such as lesions of the brain and 

 especially of the medulla oblongata, abnormal circulation in the abdomen, 

 diseases of the heart, lungs and liver, cholera, and many other diseases. 

 The continued presence of sugar in human urine, sometimes in very con- 

 siderable quantities, occurs in DIABETES MELLITUS. In this disease there 

 may be an elimination of 1 kilogram or even more of dextrose per day. 

 In the beginning of the disease, when the quantity of sugar is still very 

 small, the urine often does not appear abnormal. In the more developed, 

 typical cases the quantity of urine voided increases considerably, to 

 3-6-10 liters per day. The percentage of the physiological constituents 

 is as a rule very low, while their absolute daily quantity is increased. 

 The urine is pale, but of a high specific gravity, 1.030-1.040 or even higher. 

 The high specific gravity depends upon the quantity of sugar present, 

 which varies in different cases, but may reach 10 per cent. The urine is 

 therefore characterized in typical cases of diabetes by the very large 

 quantity voided, by the pale color and high specific gravity, and by its 

 containing sugar. 



That the urine after the introduction into the system of certain medici- 

 nal agents or poisonous bodies contains reducing substances, conjugated 

 glucuronic acids, which may be mistaken for sugar, has already been men- 

 tioned. 



The properties and reactions of dextrose have been considered in a 

 previous chapter, and it remains but to mention the methods for the detec- 

 tion and quantitative determination of dextrose in the urine. 



The detection of sugar in the urine is ordinarily, in the presence of not 

 too small quantities, a very simple task. The presence of only very small 

 quantities may make its detection sometimes very difficult and laborious. 

 A urine containing proteid must first have the proteid removed by coagu- 

 lation with acetic acid and heat before it can be tested for sugar. 



The tests which are most frequently employed and are especially 

 recommended are as follows : 



TROMMER'S Test. In a typical diabetic urine or one rich in sugar this 

 test succeeds well, and it may be performed in the manner suggested on 

 page 207. This test may lead to very great mistakes in urines poor in 

 sugar, especially ^ when they have at the same time normal or increased 

 amounts of physiological constituents, and therefore it cannot be recom- 

 mended to physicians or to persons inexperienced in such work. Normal 

 urine contains reducing substances, such as uric acid, creatinine, and others, 

 and therefore a reduction takes place in all urines on using this test. A 

 separation of copper suboxide does not generally occur, but still if one 

 varies the proportion of the alkali to the copper sulphate and boils, there 

 takes place an actual separation of suboxide in normal urines, or a peculiar 



