108 ACIDOSIS, ACETON^EMIA, 



human diabetes, glycogen is absent from the liver 

 and muscles in all but mild cases. 



Returning to the question of acidosis in diabetes, 

 we are now able to understand why it is so marked 

 and so fatal an occurrence. We saw that the cause of 

 acidosis was the failure of the tissues to obtain sugar. 

 Obviously severe diabetes will be a far more potent 

 factor in leading up to this condition than even 

 starvation. And indeed, of severe cases of diabetes, 

 that is, cases in which complete deprivation of 

 carbohydrate food will not abolish the glycosuria, 

 about four-fifths die in coma. Most of us have known 

 instances. It may have been a young man or woman, 

 the victim of diabetes certainly, but otherwise 

 apparently in good health, with only the fatal red 

 fringe on touching the urine with ferric chloride to 

 hold out any warning. There was a long walk, a 

 feverish cold, an anaesthetic ; or some physician too 

 suddenly instituted a severe deprivation of carbo- 

 hydrate food, and within a few hours coma had set 

 in, and death was inevitable. 



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-oxy butyric acid. It 

 has been usual to estimate it by the amount of 



