174 ACIDOSIS, ACETONEMIA, 



diacetic acid is present. Von Noorden has a daily 

 quantitative analysis made of the excretion of 

 /3-oxybutyric acid, and with this safeguard, which 

 of course involves a complicated procedure, strict 

 dieting is often safe. Patients with the acids in the 

 urine may live for many years. 



Apart from an analysis of the excretion of /3-oxy- 

 butyric acid, it will usually be justifiable to limit the 

 carbohydrates, provided that the patient is carefully 

 watched for any slight drowsiness, vomiting, or air- 

 hunger, and, further, that the urine is kept alkaline 

 with sodium citrate. Fortunately, feeding diabetics 

 on fat does not greatly increase the excretion of 

 acetone bodies, if the lower fatty acids in butter are 

 washed out with cold water before it is taken. 



When there is severe acidosis, as evidenced by the 

 quantity of diacetic and /3-oxybutyric acids in the 

 urine, or when there are threatening symptoms such 

 as a little tendency to drowsiness or vomiting, it is 

 necessary at all costs to get in carbohydrate at once. 

 The most effectual method of doing so, and one which 

 only very slightly increases the glycosuria, is to adopt 

 von Noorden' s oatmeal treatment. He allows nothing 

 for three or four days but seven or eight ounces of 

 oatmeal, given as gruel every two hours, with butter, 

 eggs, and vegetable protein, tea, coffee, wine, or 

 whisky. Then for a day or two he gives nothing 

 but vegetables. 



The effect on the acidosis is usually very marked, 

 the ferric chloride reaction disappearing in a few 

 days. The glycosuria also may improve to a con- 

 siderable extent. It is extraordinary that so much 



