158 ACIDOSIS, ACETONEMIA, 



catastrophes, prolonged vomiting, or diarrhoea. The 

 amount of acetone and other bodies is large only if 

 the starvation is prolonged. 



Cyclical vomiting is a curious and not uncommon 

 condition, usually seen in young children, who for a 

 few hours or days at intervals get bouts of drowsiness 

 and vomiting, which are accompanied by the excre- 

 tion of acetone and these acids. The attacks usually 

 pass off harmlessly. 



Delayed chloroform poisoning is considered at some 

 length in Chapter XI. 



It is known that an unusual sequence of overdosing 

 with salicylates is drowsiness with vomiting, some 

 collapse, and particularly hissing dyspnoea or air- 

 hunger. Here again the above substances are excreted 

 in the urine. 



The presence of acetone, indeed, is perfectly 

 physiological. On an ordinary diet we excrete about 

 O'Oi to o"03 gram of acetone daily in the urine and 

 rather more in the breath, but these amounts are 

 too small to be recognized by clinical methods. 

 During starvation the excretion by the seventh day 

 may be forty times as much (F. Miiller). Diacetic 

 and oxybutyric acids are not normally present in 

 the urine. 



ORIGIN OF ACETONE, DIACETIC ACID, AND 

 f3-0XYBUTYRIC ACID. 



It was at first supposed that these were all derived 

 from glucose, because of their appearance in diabetes ; 

 at a later time they were accredited to the proteins ; 

 but it is now definitely established that they are the 



