112 ACIDOSIS, ACETON^EMIA, 



them by fats and proteins. To prevent the formation 

 of the abnormal acids from fat in the absence of 

 available sugar, the indications are to reduce the fats 

 and to supply carbohydrates. The one has to be 

 weighed against the other. 



The general treatment of diabetes is not dis- 

 cussed here. The writer has neither the space nor the 

 special experience which would be necessary. \Ye 

 shall confine ourselves to the physiological problem 

 of averting diabetic coma. 



Let it be an axiom that no case of diabetes is 

 suddenly to be put on a carbohydrate-free diet on 

 first acquaintance. Particularly would this be 

 dangerous if he already had diacetic and /3-oxybutyric 

 acids in the urine. If they are absent, that is, if there 

 is no red colour on bringing the urine into contact 

 with ferric chloride, a strict diet will be safe and 

 valuable. 



It would be going too far to say that severe limita- 

 tion of the carbohydrates is never indicated when 

 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 



