Hirschfeld found that when he put two individuals on light diet, consisting only of proteids and fat, diminution of albumin of the body, as well as tonuria, was produced. When drates were added to the food the tonuria diminished, and that to a much greater degree than the diminution of albumin. Ingestions of fat had lutely no influence in diminishing tonuria, although it diminished the loss of nitrogen. Acetonuria is more marked when the albuminous food is scarce than when it is given in great quantities. The ingestion of carbohydrates has an ordinarily rapid effect on the production of acetonuria, the quantity of acetone being considerable within two hours. Experiments in persons who were almost starving have proved that a moderate quantity of carbohydrates was sufficient to bring about marked diminution of tonuria in spite of the considerable loss of albumin and fat which still took place. Objections to the view that c-al acetonuria is due to autointoxication.
It was formerly thought that, apart from diabetes, acetonuria might occur in the fasting state, in fever, and in special dis eases, such as carcinoma. The increased production of acetone was looked upon as the result of increased albuminous de composition. This rests on a false basis. It was known that acetone was present in the urine in people fed exclusively on albuminous foodstuffs and fat, and that the increase disappeared when carbohy drates were taken. The author showed that even small quantities of carbohy drates had a very considerable effect on the acetone excretion; that the acetonu ria found in febrile affections and in car cinoma could be made to disappear when abundant carbohydrate foodstuffs were given, and that it increased when the patient could eat less. The question of acetonuria in diabetes is in accord with the view of its connection with carbo hydrate metabolism. There is very little difference between the healthy and dia betics, as long as the latter can deal with the largest part of the carbohydrate food stuffs supplied, but when the carbo hydrates are excreted as sugar the ace tone in the urine is increased. The difference between the healthy and dia betics is that in the latter, notwithstand ing abundant carbohydrate foodstuffs, acetone excretion is abundant, and that, whereas in the healthy the acetone in the urine does not exceed 0.9 gramme, in the diabetic it is much above 1 gramme. It is only correct to speak of a patho logical acetonuria in diabetes. Hirsch feld (Cent. f. inn. Med., June 13, '96).
Geelsuyden, from his experiments on rabbits and dogs already mentioned, reached the conclusion that acetone is formed in the tissues, not in the kid neys; that the kidneys give passage to the acetone even when their blood con tains a very small quantity of it; and that pathological acetonuria is not caused by a defect of disintegration of acetone in the body, but by a disorder of the general metabolism leading to the for t, mation of an anomalous large quantity of acetone. Geelsuyden has further con
ducted a series of experiments in healthy individuals (medical students) put on dif ferent scales of diet, which were strictly controlled. As all observers did, Geel suyden found that when a person was put on exclusive flesh diet acetonuria appeared, and at the same time the body lost albumin as well as fat; when large quantities of proteids were ingested, ace tonuria was less considerable than when less albumin was given. Complete star vation, an exclusive fat diet, and a diet of proteids, with the addition of a great quantity of fat, cause a very considerable amount of acetone to be excreted. As exclusive diet of fat and complete star vation give rise to the excretion of the largest quantity of acetone, it seems that acetone is formed by disintegration of fat, and that in this respect there is no difference between the fat of the food and that of the tissues. Carbohydrates have a great power to check the excre tions of acetone; when individuals were put on a diet without carbohydrates and secreted urine containing a great quan tity of acetone, the acetonuria disappeared in a few hours when carbohydrates were given. From 150 to 200 grammes of carbohydrates per day are required to check an already existing alimentary acetonuria.
In the opinion of Geelsuyden, ace tonuria occurs when carbohydrates are not ingested in sufficient amount, and acetone is formed by the disintegration of fat, either of that of the tissues or of that contained in the food.
Preliminary Tests for .Acetone.—With an alkaline solution of sodium nitrocv anide (of a slightly-red hue) acetone gives a ruby-red color, changing, after some time, to yellow, and after acidifying with acetic acid and to greenish violet.
The cyanide-of-soda test, after Legal or le Nobel (see below), may be employed as preliminary test; but, to make the presence of acetone positive, it is neces sary to separate it from the urine by distillation. As the boiling-point of ace tone is low (56° C.), this may be done at a low temperature, and the use of a water-bath is recommended.