In fevers, as well as in diabetes, ace tonuria is often accompanied by excre tion of diacetic acid and beta-oxybutyric acid.
The Origin and Pathological Signifi cance of Acetone, Diacetic Acid, and Beta-oxybutyric Acid. — The origin of acetone in the organism has not yet been ascertained. Cantani was of the opinion that it was formed in functional disor ders of the digestive tract; Petters and Kaulich argued that it was due to fer mentations in the bowels. Markownikoff ascribed it to a fermentative product of sugar.
Acetonuria of intestinal origin cannot be denied, but its occurrence from this cause is probably much rarer than many have imagined. S. Boeri (Revista Clin. e Terapeutica, Nov., '91).
The development of acetonuria from affections of the intestines of the most varied character is a phenomenon so con stant that it would be well to add to the already recognized varieties of the con dition a class caused by intestinal dis turbances. In these cases of digestive fault it seems impossible to separate acetonuria and diaceturia, in that the differences in clinical manifestations be tween these substances are but slight, and really only quantitative in charac ter, and the combination or alternation of the two conditions is almost always the case. The symptoms formerly attrib uted to these substances do not appear to be due to them, but to lower oxidized forms. When albuminuria exists it does not seem to be in any way dependent upon either of these substances. Ace tone is to be found (sometimes in large amounts) in the contents of the stomach and intestine in many cases. There is a great difference between the primary and secondary gastro-intestinal affections, especially of nervous origin; in the for mer the gastric contents almost always contain acetone; in the latter it is rarely found. In several cases oxybutyric acid was also found in the urine. Lorenz (Oesterr.-ungar. Cent. f. d. med. Wissen., '91).
Experiments to ascertain whether Mayer's view that acetonuria is an evi dence that an acid intoxication of the organism exists are correct.
Strychnine poisoning produced in a number of dogs, thus causing an acid in toxication through the muscular spasm. In no instance was acetonuria the result. Acetone looked for in 31 epileptics also, after convulsions, and found in only 13 instances and in but small quantities; several of these patients had acetone in their urine before the convulsions.
To see whether acetone comes from the gastro-intestinal tract calomel was given to a diabetic girl that showed acetonuria. Were the acetone formed in the gastro intestinal tract it would seem probable that after the disinfecting and purgative action of the calomel the quantity of the urine would be less. On the contrary, the amount was rather greater than less, and at any rate it was not decreased. Hugo Ltithje (Centralb. f. innere Med., Sept. 23, '99).
The necessary condition for the pro duction of acetonuria is an insufficient decomposition of hydrocarbons, either from their absence in the diet or from impaired powers of decomposition on the part of the organism (diabetes). In ad vanced diabetes acetonuria is a grave symptom, threatening coma. This coma may be delayed by the administration of large doses of sodium bicarbonate. It is Probable that the bodies of the acetone series are formed in considerable quantity in the organism, to disappear completely later. They doubtless represent links in a continuous series of transformations in which oxybutyric acid-beta is the pri mordial term. H. C. Ceelsuyden (Norsk Mag. f. Laegevidensk., July, 1900).
Albertoni did not find acetone in the urine of animals which had received large doses of glucose (100 grammes) or of different primary saturated alcohol; when isopropylalcohol was ingested it was excreted partly unaltered and partly changed to acetone, and when acetone was given to animals it was discharged by the urine, even if the dose of acetone ingested did not exceed S centigrammes.
When Gerhard detected the presence, in the urine, of a substance which gave a dark, wine-red color by means of a solution of perchloride of iron, he be lieved this substance to be diacetic ether, and was of the opinion that acetone was derived from this substance, which can easily be disintegrated into acetone, alco hol, and carbonic acid. Fleischer and Tollens proved this to be an error, and found that the coloring substance—at least, in the majority of cases—must be diacetic acid, which can be separated from the urine by the addition of sul phuric acid and extracted with ether. This opinion is supported by von Jaksch. Minowski caused acetonuria by extir pation of the pancreas, and von :Kering by intoxication with phloridzin.