EFFECTS OF CERTAIN DRUGS AND POISONS 723 



noted. Recently McDaiiell and Underliill have accomplished further work, 

 showing that ~ sodium chlorid produces glycosuria with neither 



& v> 



relative nor absolute hyperglycemia. 



Hvperglycemia has also been found by others, but only when concen- 

 trated saline solutions were injected. According to Wilenko intravenous 

 injection of 20 per cent saline produces by stimulation of the central 

 nervous system a hyperglycemia in which the muscles and probably the 

 liver lose glycogen. He concluded that the nervous stimulation is a sodium 

 ion effect and that owing to osmotic factors the permeability of the kidney 

 is first increased and then decreased. Hirsch also obtained hyperglycemia 

 from concentrated (10 per cent) sodium chlorid; 2.5 per cent or more 

 dilute solutions did not increase the blood sugar nor did sodium car- 

 bonate, sodium acetate or calcium chlorid. He favored the central nerv- 

 ous system theory, which, however, fails to account for the non-appearance 

 of hyperglycemia with the dilute injections. 



Burnett has demonstrated the inhibiting effect of potassium salts upon 

 the glycosuria produced by sodium salts, thus adding weight to the im- 

 portance of the ions wherever the action may be exerted. 



That the point of action of the ion antagonism in salt glycosuria is 

 renal seems difficult to doubt in the light of the recent experiments of 

 Hamburger, Brinkmann and their co-workers (a) (/;). These invest igators 

 have studied the permeability of the glomerular membrane in the frog (the 

 tubules being anatomically separated therefrom in this animal). They 

 have demonstrated clearly the power of the glomeruli to retain free 

 dextrose, but have also shown that this power depends upon the main- 

 tenance of a very delicate ion balance in the perfusion fluid. While Ham- 

 burger's attention was confined more to the calcium-potassium relations 

 and the bicarbonate requirement, it is obvious that conditions which alter 

 the sodium-ion concentration are likely to disturb seriously the entire ion 

 balance. This applies to ion physiology in general, as shown by Loeb, and 

 to the instance of salt glycosuria in particular, as shown by the calcium 

 antagonism of Fischer and of Underbill and the potassium antagonism 

 of Burnett. 



An interesting practical deduction which Hamburger makes is that 

 the oatmeal treatment in diabetes mellitus may owe its value to bolstering 

 up the retaining power of a glucose-surfeited glomerular membrane by 

 the excess of potassium ions contained in that food. Hamburger's (&) work 

 should lead to a new understanding of the various types of renal glycosuria, 

 of which sodium chlorid glycosuria appears to be a notable example. 



Salt Starvation, A deficient salt intake leads to emaciation, the oc- 

 currence of acetone in urine and breath and other untoward symptoms. A 

 generally lowered mineral excretion results. The nitrogen balance ap- 

 pears to be but little affected (Rosemami(e)). 



