502 



SUGAR IN THE URINE. 



Quantitative estimation is made by fermentation or by the titration-method. 

 The estimation by circumpolarization is, according to Worm-Muller, almost value- 

 less for the estimation of the amount of sugar in diabetic urine, as the urine 

 often contains in part as yet unknown optically active substances. If, however, 

 it be desired to employ this method, the urine must be previously agitated with 

 commercial animal charcoal and filtered, in consequence of which it becomes 

 colorless. Small amounts of glycogen derived from urinary tubules that have 

 undergone glycogenic degeneration have been found by Leube in diabetic urine. 



After ingestion, the sugars that are most readily decomposed pass with greatest 

 difficulty, while those that are not at all decomposable pass most readily, into 

 the urine. If, therefore, considerable amounts of dextrose are administered, a 

 portion thereof passes into the urine; and a larger amount in cases of diabetes 

 than in health. Ingested levulose does not increase the amount of sugar in the 

 urine of a diabetic patient. The use of starch in considerable amounts never 

 gives rise to the presence of sugar in the urine in health, although it increases 

 the amount of sugar in cases of diabetes. The ingestion of cane-sugar or of milk- 

 sugar in considerable amount causes the passage of small amounts of each into 

 the urine during health. The diabetic, under such circumstances, excretes an 

 increased amount of dextrose. According to Kulz, the cane-sugar ingested by 

 a diabetic patient is decomposed into grape-sugar and fruit-sugar; the latter is 



consumed in the body, the 

 former in part excreted. The 

 same takes place with milk- 

 sugar. 



Levulose is rarely present 

 in the urine, constituting levu- 

 losuria. 



In severe cases of diabetes 

 mellitus, Kulz found levorota- 

 tory fi-oxybutyric acid, the next 

 higher analogue of lactic acid, 

 in the urine, from the oxida- 

 tion of which diacetic acid is 

 produced. The latter, in its 

 turn, is readily decomposed 

 into carbon dioxid and acetone. 

 /3-oxybutyric acid is never 

 wanting when diabetic coma is 

 present. Acetone is present in 

 the urine of diabetics often in 

 considerable amount, princi- 

 pally in association with pro- 

 gressive loss of strength, and 

 often even in spite of admin- 

 istration of carbohydrates. 

 From oxybutyric acid there 

 results, by dehydration, a-cro- 

 tonic acid, which Stadelmann found in diabetic urine. As albuminuria results from 

 administration of acetone, the complication of albuminuria with diabetes is clear. 

 Milk-sugar lactosuria is present in the urine of puerperal women, together 

 with glucose and isomaltose, chiefly in connection with milk-stasis. The condition 

 is thus due to absorption from the breasts. Milk-sugar likewise appears in the 

 urine of infants with derangement of digestion. 



Pentose has, on several occasions, been observed in the urine: pentosuria. 

 This substance contains 5 atoms of carbon, is not susceptible of fermentation, 

 and is capable of causing reduction. It may possibly be due to disease of the 

 pancreas. Phloroglucin and hydrochloric acid yield a red color. Pentose is 

 present in coffee, in many wines, and in varieties of milk and sugar. Ingested 

 pentoses arabinose, xylose pass over into the urine. 



Reichart has called attention to the simultaneous appearance of dextrin in 

 urine containing sugar. Inosite has been found both in cases of diabetes and 

 in cases of polyuria and albuminuria. Traces of it are contained even in normal 

 urine. _ Occasionally, "sugar-puncture" in animals is followed by the appearance 

 of inosite instead of dextrose in the urine. For the detection of inosite, the 

 dextrose is removed by fermentation, and albumin by boiling after addition of 

 a few drops of acetic acid and sodium sulphate. Of the filtrate, a few cubic 



FIG. 162. A, crystals of cystin; B, of calcium oxalate; c, hour- 

 glass shaped crystals of calcium oxalate. 



