458 METABOLIC ABNORMALITIES, AUTOINTOXICATION 



Infantile marasmus, 1 in which increased ammonia is found 

 in the urine, and sometimes symptoms resembling acid intoxica- 

 tions occur. Normally the urine of suckling infants contains 

 1-4 mg. per day of acetone bodies, which may be increased to 

 15-35 mg. by simple hunger. In fact, "acidosis" seems to 

 occur particularly frequently in infants from relatively slight 

 causes, such as gastro-enteritis and other infectious conditions. 

 This is perhaps due to a lower oxidizing power on the part of the 

 infantile organism (Pfaundler 2 ), since the proportion of nitrogen 

 in the urine of infants in forms other than urea, is higher than 

 in adults. Even an unusually fatty diet may cause acetonuria 

 in infants. 



Cancerous cachexia, in which a " cancer coma " occasionally 

 occurs that is strikingly like that of diabetic coma. 



Retention of placenta or fetus, acetonuria being considered of 

 diagnostic value in determining the death of the fetus in utero? 



Pernicious vomiting of pregnancy is often associated with 

 acetonuria, 4 which in some cases is probably dependent upon 

 starvation and proteid wasting, 5 but in other cases is probably due 

 to liver alterations resembling those of puerperal eclampsia or 

 acute yellow atrophy. 6 Williams 7 considers that this condi- 

 tion may result from three varieties of etiological factors, 

 namely reflex, neurotic, and toxemic. Only in the last form, 

 which is associated with marked degenerative changes in the 

 liver, are there striking metabolic changes. These are indicated 

 by a marked increase in the ammonia nitrogen of the urine, 

 which he has observed to form as much as 46 per cent, of the 

 total nitrogen. Starvation seldom causes a rise in the ammonia 

 quotient above 1015 per cent., and Williams considers that 

 an ammonia quotient of over 16 per cent, is an indication for 

 the interruption of pregnancy, and even then the prognosis is 

 dubious. 



In febrile diseases, especially in children, acetonuria is 

 often observed, apparently depending on wasting of the tissue 

 proteids. 



In uremia, as previously mentioned, organic acids may ap- 

 pear in the urine, but apparently as a result, and not as the 

 cause, of the uremia (Orlowski). 



1 See Meyer and Langstein, Jahrb. f. Kinderheilk., 1906 (63), 30. 



2 Jahrb. f. Kinderheilk., 1901 (54), 247. 



8 See Frommer, Berl. klin. Woch., 1905 (42), 1008. 



* Baldwin, Amer. Jour. Med. ScL, 1905 (130), 649. 



5 Wolf, New York Med. Jour., 1906 (83), 813. 



6 Ewing, Amer. Jour, of Obstet, 1905 (51), 145. 



7 Johns Hopkins Hosp. Bull., 1906 (17), 71 ; full bibliography. 



