694 URINE. 



tissue, and the creatinine, according to FOLIN, is a product of the endo- 

 genous protein metabolism. 



Reports as to the behavior of the creatinine elimination with work 

 are conflicting, v. HOOGENHUYZE and VERPLOEGH, who made use of 

 a much more trustworthy method of quantitative estimation than their 

 predecessors, find that muscular activity as a rule does not cause any 

 rise in the creatinine elimination, and that in man such a rise with work 

 occurs only when the body is obliged to live upon its own tissues. S. 

 WEBER 1 also finds an absolute increase in the elimination of creatinine 

 only in starving dogs. Other investigators could not find any increase 

 in the elimination of creatinine by work, although such a rise was found 

 as shown by PEKELHARING and HARKiNK, 2 by the muscle tonus. 



In starvation a decrease in the creatinine but a simultaneous increase 

 in the elimination of creatine has been found in man (v. HOOGENHUYZE 

 and VERPLOEGH, CATHCART, BENEDICT and MYERS 3 ). Such an increase 

 in the creatinine elimination only occurs in those conditions which are 

 accompanied by acidosis, and correspondingly it can be prevented by 

 the introduction of carbohydrates (CATHCART, MENDEL and ROSE) 

 The creatinine elimination in certain cases has therefore been explained 

 by a disturbed carbohydrate metabolism. This is neverthless on the 

 other hand disputed by WOLF and OESTERBERG 4 who find that the crea- 

 tinine elimination in starvation can be arrested by the introduction of 

 proteins alone. 



Little is known about the behavior of creatinine in disease, nor are 

 the observations in accord. In anaemia and cachexia the elimination 

 of creatinine is diminished, and when the metabolism is increased the 

 elimination is also increased. That this is the case, at least in fevers, 

 seems to be borne out by several concurrent observations. 5 In diseases 

 of the liver a diminished elimination of creatinine may occur, and in cases 

 of carcinoma of the liver considerable creatine has been found in the urine 

 (v. HOOGENHUYZE and VERPLOEGH, MELLANBY). The role of the liver 

 in the creatine-creatinine metabolism, is, as has already been mentioned 

 in Chapter X, not clear. The exclusion of the liver from the metabolism 

 of a dog with Eck fistula had no result in the experiments of TOWLES 



1 Arch. f. exp. Path. u. Pharm., 58. Further literature may be found in v. Hoeg- 

 enhuyze and Verploegh, Zeitschr. f . physiol. Chem., 46. 



2 Maillard and Clausmann, Journ. de Physiol. et de Path., 12; Prayon, Maly'a 

 Jahresb., 40; Pekelharing and Harkink, Zeitschr. f. physiol. Chem., 75. 



3 v. Hoogenhuyze and Verploegh, Zeitschr. f. physiol. Chem., 57; Cat heart, Bioch. 

 Zeitschr., 6; Benedict and Myers, Amer. Journ. of Physiol., 18; Jaffe, 1. c. 



4 Cathcart, Jour, of Physiol., 39; Mendel and Rose, Journ. of biol. Chem., 10; 

 Wolf and Osterberg, Bioch. Zeitschr., 35; Wolf, Journ. of biol. Chem., 10. 



6 See O. af Klercker, Zeitschr. f. klin. Med., 68. 



