ACETONE BODIES. 773 



show that the acetone bodies are not entirely derived from the proteins. 

 In man the excretion of acetone does not increase with the rise in the 

 quantity of protein, and an increase in the latter above the average causes 

 a diminution in the elimination of acetone (ROSENFELD, HIRSCHFELD, 

 FR. VoiT 1 ). The carbohydrates cannot be considered as material for 

 the formation of acetone bodies. It is generally admitted that in man 

 the exclusion of carbohydrates from the food or the diminution in their 

 amount or their assimilation may lead to more or less increased elimina- 

 tion of acetone bodies. This behavior may occur in diabetes as well as 

 in starvation and in the above-mentioned diseased conditions. The 

 increased elimination of acetone with food lacking carbohydrates also 

 occurs in healthy persons with a fatty diet but with a sufficient supply of 

 calories in other ways (alimentary acetonuria). With an abundant 

 supply of carbohydrates the elimination of acetone bodies may be greatly 

 diminished or even stopped entirely. The carbohydrates therefore 

 act " antiketoplastic," and a similar retarding action can be produced 

 by certain other substances, such as glycerin (HIRSCHFELD), tartaric 

 acid, lactic acid and citric acid (SATTA) , alanine and asparagin (BORCHARDT 

 and LANGE 2 ) . Certain bodies like glycerin, lactic acid, alanine, asparagin, 

 which cause a sugar formation or increased elimination of sugar, act in 

 the same way. 



It must not be overlooked that the conditions are different in man 

 and in other carnivora (GEELMUYDEN, FR. VOIT). In dogs the elimina- 

 tion of acetone bodies is not increased in starvation, but is reduced; it 

 is augmented with increased quantities of meat, runs parallel with the 

 nitrogen excretion, and is not diminished by carbohydrates (FR. VoiT 3 ). 

 In spite of this divergent behavior an unmistakable relation also exists 

 in the dog between the elimination of acetone bodies and the carbo- 

 hydrate metabolism, because in phlorhizin diabetes the acidosis occurs 

 only after the glycogen has been consumed (M ARUM 4 ) . 



As the carbohydrates cannot be acetone-formers, then a second 

 source only remains, namely the fats. As proof of this there are certain 

 cases of diabetes with strong elimination of acetone bodies (/?-oxybutyric 

 acid) where the quantity of protein transformed was too small to account 

 for the acetone bodies (MAGNUS-LEVY). The free elimination of acetone 

 bodies in starvation may also depend upon the fact that a great part of 

 the body fat is consumed, and in several cases a certain relation has 



1 Hirschfeld, Zeitschr. f. klin. Med., 28; Geelmuyden, see Maly's Jahresber., 20, 

 and Zeitschr. f. physiol. Chem., 23 and 26; Rosenfeld, Centralbl. f. innere Med., 16; 

 Voit, Deutsch. Arch. f. klin. Med., 60. 



2 1. c. Hofmeister's Beitrage, 9, which also- cites the other works. 



3 See footnote 1. 



4 Hofmeister's Beitrage, 10. 



