820 URINE. 



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 forma- 

 tion 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), lactic acid 

 and glutaric acid (BAER and BLUM) alanine and asparagin (FORSSNER, 

 BORCHARDT and LANGE 2 ). Certain bodies like glycerine, lactic acid, 

 alanine, asparagin, which cause a sugar formation or increased elimina- 

 tion 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 (MARUM 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 (0-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 



1 Hirschfeld, Zeitschr. f. klin. Med., 28; Geelmuyden, see Maly's Jahresber., 26, 

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

 Voit, Deutsch. Arch. f. klin. Med., 66. 



2 Borchardt and Lange, 1. c.; Hofmeister's Beitrage, 9; which also cites other 

 works; Baer and Blum, ibid., 10; Forssner, Skand. Arch. f. Physiol., 25. 



3 See footnote 1. 



4 Hofmeister's Beitrage, 10. 



