AND DIABETES 101 



cases both these causes are combined, as when a 

 patient with a perforated gastric ulcer, who has 

 absorbed nothing for hours, is given chloroform. 

 The vomiting induced by the acetonaemia of course 

 prevents the retention of carbohydrate food, and so 

 the bad becomes worse. 



Salicylates presumably act by paralysing that 

 function of the tissues which enables them to take 

 up sugar from the blood. As we shall see, this is 

 also the pathology of diabetes. The tissues, starved 

 of sugar, break down the fat to acids and acetone 

 instead of to carbon dioxide and water. In the 

 vomiting of pregnancy it is very probable that the 

 formation of acids and acetone is due merely to the 

 prolonged and severe starvation necessitated by the 

 vomiting, but as soon as they are produced in excess, 

 they complete the mischief already wrought, and the 

 patient, if unrelieved, may die in coma. 



THE MECHANISM OF POISONING IN ACIDOSIS 

 AND ACETONAEMIA. 



Neither acetone, diacetic acid, nor ^-oxybutyric 

 acid is poisonous, except in quite large doses. Why 

 then do such marked and indeed fatal symptoms 

 occur when they accumulate ? 



The blood is normally alkaline. All the functions 

 of the tissues are attuned to a medium of a particular 

 alkalinity. If this alkalinity is greatly reduced, 

 almost to the point of neutralization, the symptoms 

 produced experimentally are not dependent on the 

 particular acid used. They include dyspnoea, collapse, 

 and coma. In diabetic coma the alkalinity of the 



