456 METABOLIC ABNORMALITIES, AUTOINTOXICATION 



of exudates, in carcinoma, and in starvation or other conditions 

 with great wasting of the tissues. 1 



On the other hand, the amount of acids sometimes found in 

 the urine seems to be greater than can be explained by the 

 proteid destruction that occurs (Magnus-Levy 2 ), and hence it 

 has been thought that acetone bodies may be derived from the 

 fats. /3-oxybutyric acid can be readily produced from fatty 

 acids, especially, of course, from butyric acid, and Schwarz 

 observed an increase in the acetone excretion in a diabetic given 

 large quantities of butter. Other higher fatty acids were also 

 found to cause increased acetone excretion. Joslin, 3 however, 

 found that butyric acid does not increase the acetonuria of a 

 healthy, fasting individual, nor do neutral fats ; oleic acid and 

 sodium palmitate, on the other hand, caused a marked aceton- 

 uria. It is furthermore possible, but this is purely hypothetical, 

 that the acetone bodies may be synthesized from other simpler 

 substances. 



Sarcolactic acid appears in the urine, particularly when the 

 liver is badly incapacitated, and, therefore, is rarely found in 

 diabetes, but is a prominent finding in phosphorus-poisoning, 

 acute yellow atrophy, and in puerperal eclampsia. (See preceding 

 sections of this chapter.) The amount is never sufficient to 

 cause an acid intoxication by abstraction of alkali from the 

 blood, nor does it seem to possess sufficient toxicity to cause all 

 of the manifestations of puerperal eclampsia, as has been sug- 

 gested. It is normally present in the muscles, being produced 

 in increased amounts during exercise, and therefore it may 

 appear in the urine after violent and protracted muscular 

 exertion ; apparently this acid is destroyed in the liver through 

 oxidation, and therefore appears in the urine when the liver is 

 disorganized, but there is also much reason for believing that 

 under these conditions the sarcolactic acid found in the urine 

 comes from the disintegrating cells themselves. 4 Sarcolactic 

 acid, which is dextrorotary, must be distinguished from its 

 optical isomer, the inactive lactic acid that is produced by 

 fermentation. When this fermentation lactic acid is formed in 



1 Kesume by Mauban, These de Paris, 1905. 



2 Arch. exp. Path. u. Pharm., 1899 (42), 149. 



3 Jour. Med. Research, 1904 (12), 433. 



4 Mandel, however, considers that sarcolactic acid comes from carbo- 

 hydrates, since phosphorus-poisoning does not cause the appearance of lactic 

 acid in the urine of dogs with experimental (phlorhizin) diabetes, and when 

 produced by phosphorus-poisoning the administration of phlorhizin checks it 

 (Amer. Jour. Physiol., 1905 (13), p. xvi) ; also see Mandel and Lusk, ibid., 

 1906 (16), 129. 



