Case of cerebral apoplexy in which sugar and acetone were detected in the urine. The coma had come on suddenly, and was regarded as diabetic from the urinary condition; but the autopsy re vealed an extensive cerebral hamnorrhage. Ruttan and Johnston (Montreal Med. Jour., Mar., '91).
Geelsuyden draws the conclusion from many experiments on rabbits that, even when small (10 to 20 milligrammes) subcutaneous injections of acetone are given, the acetone is excreted with the urine; in larger doses more acetone is excreted; but only a portion of the in jected quantity reappears; another por tion of it is excreted with the expired air; but still a portion is left which does not reappear and must therefore have been disintegrated in the body of the animal. After the injections albumi nuria takes place. An adult rabbit can bear an injection of 2 grammes of ace tone, but is killed by the injection of 6 grammes. In starving animals the ex periments gave the same results; a por tion of the injected acetone reappeared in the urine and the expired air, while still another portion was disintegrated in the body. Geelsuyden draws from these experiments the conclusion that the ace tonuria observed in starving individuals is not caused by a diminution of the power to disintegrate acetone already formed in the but to an increase of the amount of acetone formed in the body.
Modern authors generally admit that acetone is a product of the metabolism of proteids. Honigmann and von Noor den are of the opinion that acetone is only formed by diminution of the organ-• ized albumin of the body, and never by the metabolism of the proteids ingested with the food, be the quantity ever so large. Honigmann supported this theory principally by experiments made on him self, which proved that when he lived exclusively on large quantities of proteids —that is, when nutrition was insufficient —acetone and diacetic acid were found. The acetonuria was not augmented when more albumin was ingested, but disap peared when he took plenty of carbohy drates in addition to the proteids. Von Engel, on the contrary, is of the opinion that in all cases when great quantities of albumin arc decomposed in the body the quantity of acetone excreted with the urine will increase considerably,—equally if the albumin is ingested with the food or taken from the stock of the body.
Relations existing between patholog ical acetonuria and azoturia in several diseases (diabetes mellitus, typhoid fe ver, pneumonia, phosphorus poisoning): acetone seems to increase, especially in those cases where destruction of allymni noid matters is also increased, whether they be of organic nature or belong to the albumin of alimentation. A direct proportion between the amounts of ace tone and albumin has not been observed. A solution between the two is some times observed, but it is by no means constant. Palma (Jou•. de M6d. de Chir. et de Pharm. Bruxelles, Feb. 2, '95).
Twenty-six cases of acetonuria stud ied. In physiological pregnancy at the ninth month the acetonuria is more marked than in the non-pregnant state. In labor the acetonuria increases, espe cially if the parturition be prolonged. In the puerperium it diminishes, remain ing, however, greater than in pregnancy till after the sixth day. The view that acetonuria can he regarded as a sign of foetal death is not sustained. P.. Costa (Ann. di Ostet. e Gynec., xxiii, March, 1901).
Weintraud and Hirschfeld are decided opponents of this theory. Weintraud argues that—in a case of severe diabetes where complete equilibrium of the me tabolism, and especially of the metabo lism of nitrogen, was maintained for a long time, so that no albumin contained in the tissues was consumed—acetone, diacetic acid. and beta-oxybutyric acid were constantly excreted with the urine; the diet was free from carbohydrates; when, also, the quantity of proteids was somewhat reduced the sugar disappeared after twenty-four hours; the weight of the body was maintained, but acetone and diacetic acid were still excreted.
Carbonate of soda augmented the quantity of acetone excreted, without diminishing the quantity of oxybutyric acids. When, in periods of twenty-four hours, no food at all was taken, ace tonuria was greatly increased. Inges tion of carbohydrates diminished the acetonuria even in persons suffering from diabetes; levulose, milk, and sugar have the same property; glycerin, also, as observed by Hirschfeld. The addition of fat to the food has no power to arrest the acetonuria.