ACID INTOXICATION 457 



the stomach and enters the blood, it ordinarily, like other ingested 

 organic acids, is combined by the blood alkalies and oxidized to 

 carbonates. It is doubtful if it ever enters the urine. 1 



ACID INTOXICATION IN CONDITIONS OTHER THAN DIABETES 



Not infrequently acetone and diacetic acid, less often oxy- 

 butyric acid, are found in the urine of patients suffering from 

 the most diverse diseases. It is customary to refer to this 

 condition as "acetonemia " or " acetonuria" and to ascribe many 

 of the observed symptoms to "acid intoxication." The acetone 

 bodies, however, being without specific toxic effects, can probably 

 cause only such symptoms as described in discussing diabetic 

 coma, and these are due to their reducing the carrying power 

 of the blood for CO 2 . Therefore, the intoxication in these 

 cases is probably not due to the acids, but, on the contrary, the 

 presence of the acetone bodies is due more often to the effects 

 upon the liver of toxic substances of diverse origins and natures. 

 In no other condition do the amounts of organic acids in the 

 urine approximate the amounts found in diabetic coma. 



Anesthesia. Most prominent of these so-called acid 

 intoxications is that following a few days after anesthesia, 

 particularly with chloroform, and fully discussed by Bevan and 

 Favill. 2 As shown first by Greven (1895), and more recently 

 especially by Brewer and by Helen Baldwin, 3 acetone is nearly 

 always present in the urine during the first twenty-four hours 

 after administration of either chloroform or ether, and occasion- 

 ally diacetic acid appears on the second or third day after ; but 

 ordinarily there is no increase in organic acids in the urine. It 

 does not seem probable that the symptoms observed in typical 

 cases of delayed chloroform-poisoning are due chiefly, if at all, 

 to acid intoxication per se, but rather are the result of extensive 

 injury to the parenchymatous organs, particularly the liver, by 

 the chloroform, which causes a condition resembling acute 

 yellow atrophy or phosphorus-poisoning. 4 



Cachectic Acetonuria. Acetone and diacetic acid, but 

 less abundantly the oxybutyric acid, are found in the urine in 

 many conditions associated with wasting, among which may be 

 especially mentioned : 



1 The theory of Boix that cirrhosis of the liver may be produced by butyric 

 acid formed in gastric fermentation could not be corroborated by Joannovics, 

 Arch. int. Pharmacodyn., 1905 (15), 241. 



2 Journal Amer. Med. Assoc., 1905 (45), 691. 



3 Jour, of Biol. Chem., 1906 (1), 239. 



4 Wells, Jour. Amer. Med. Assoc., 1906 (46), 341. 



