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CHAPTER X. 



ACIDOSIS, ACETONi^MIA, AND 

 DIABETES. 



Conditions of occurrence of acetone, diacetic acid, and /3-oxy- 

 butyric acid — Origin from fats — Sugar starvation the cause of 

 acidosis — Acid poisoning — The diagnosis of starvation — The 

 essential nature of diabetes — The treatment of non-diabetic 

 acidosis— The prevention of post-operative coma in diabetics. 



TEXTBOOKS of medicine published fifteen or 

 twenty years ago introduced us to the fact 

 that in diabetic coma, that tragic termination to so 

 many promising young Hves, the urine is loaded with 

 three substances whose relations were not well under- 

 stood — namely, acetone, diacetic acid, and /3-oxy- 

 butyric acid. A constant study of the behaviour of 

 these bodies by many observers has led to some 

 settled conclusions of considerable interest and value. 

 It has been shown that they are not peculiar to 

 diabetic coma, although in no other disease are they 

 excreted in such quantity. They appear in the urine 

 in the following conditions also : — 

 {a). Starvation. 



{h). Periodic (cycHcal) vomiting of children. 

 (c). Delayed chloroform poisoning. 

 {d). Sahcylate poisoning. 



[e). The toxaemias of pregnancy (pernicious 

 vomiting, eclampsia). 

 Starvation may be voluntary, or due to such 

 affections as gastric ulcer, fevers, acute abdominal 



