170 ACIDOSIS, ACETONEMIA, 



THE TREATMENT OF NON-DIABETIC 

 ACIDOSIS. 



It will probably be agreed that the time has now 

 come when no examination of the urine in cases of 

 diabetes, of abdominal catastrophes, of vomiting, or 

 of starvation, will be complete unless we record the 

 presence or absence of acetone and diacetic acid as 

 well as of albumin and sugar. Unfortunately there 

 is no simple clinical test for /3-oxybutyric acid. It 

 has been usual to estimate it by the amount of 

 laevo-rotation of a ray of polarized light, from which 

 of course must be deducted the dextro-rotation due 

 to any glucose which may be present. 



A fairly simple qualitative test is Stuart-Hart's : 

 Take 20 c.c. of urine, add 20 c.c. of water and a few 

 drops of acetic acid. Boil the mixture till the bulk 

 is reduced to about 10 c.c. ; thus acetone and diacetic 

 acid are driven off. Add water to restore the bulk 

 to 20 c.c. ; put 10 c.c. into each of two test-tubes, A 

 and B. To A add i c.c. of hydrogen peroxide ; just 

 warm it, but do not boil, for one minute. Cool. 

 Add to A and B |- c.c. of glacial acetic acid, a few 

 drops of fresh sodium nitroprusside, and overlay with 

 2 c.c. of ammonium hydrate. Stand four hours. If 

 /3-oxybutyric acid was present, it will have been 

 oxidized to acetone, and a purple-red ring will form 

 where the fluids meet in A, but not in B. The 

 presence of sugar does not interfere with the 

 reaction. 



The presence of acetone cannot be definitely 

 excluded without distilling the urine, but too delicate 

 tests are usually less valuable than more approximate 



