Neu.BEa 25 ANTIKETOGENESIS-WOODYATT 2109
nized tlhat a glycosaria p ersisting under a carbohydrate- geneal the treatment of severe diabets may b
free diet nTay be miade to disappear if the protein of the arried ot along the folloing ne. It e s a rue
bood es c,t down. Faîte, Gigon'0 and others have shown practically impossible to keep the patient's urine sugar-
tliat somne patients may have a marked susceptibility to free, and ne shonld early give np the attempt. Since
protein; mio.re an, in faut, than to carbohyvdrate; 50 that the main danger lies in the acidosis it is unwise to put
glycosuria may be lessened or at leaset not increased by the patient on a strict diet for any length of time. In
cuottin g down the protein and at te same time adding the prelimiary treatment there coes firt a period of
('arbolivdriate. Thl e fact is certainly now well estab- strict diet with 75 to 100 gm. of bread; then follows one
lished t hlat higli protein feeding is not desirable in of a low protein diet, cosistig chiefl of vegetable,
severe cases. Tnwo hudred gramrs of cooked meat per oand finally one con sisting of oatmeal. Each of these is
day is the maxiinum allowed by von Nboorden and not of two or three days' duration. B repeatig
omore than 12 to 15 i i.d of nitrogen should appear in this procedure for two or three weeks there may re
the urine. The proteins of eggs aud especially of vege- obtained a lowring of acidosis to sc a extet that
tables, are to be preferred to those of meat since they it ceases to be a imedite danger, ad there may be
]t often brings about a ~ ~ ~ i dcreases ngyosui and a n imhcaemus estdiaed idvduanger and theelmy byeuc
aifect the gîveosuria lesee. It is on this accout tbat obtained also a clear conception of the degree of sugar
per,iods of vegetable feeding are so beneficial. tolerance. The subsequent treatment is based on the
s\V it h rega rd to carbohvdrate feeding iu severe cases results obtained. A carbohydrate-free diet can often be
it is well known th at most patients do better when one given for a week or so with marked general improvement.
kirnd of starch is given alone than when several kinds The patient is then allowed a small amount of carbo-
are taken together. This is the basis or the rice, potato hydrate, or a more prolonged oatmeal or vegetable diet
and oatseal treatments. Of these the oatmeal treat- may be given. Every few weeks a period of strict pro-
meui t is of greatest importance. The manner of its tein-fat feeding of two or three days may be ordered,
action is not understood, but the beneficial effects fol- and once or twice a year a longer period, two or three
lowing its use are at timues remarkable. All patients are weeke, shonld be tried. lu conclusion it muet be
not by any means, however, equally affected. Although emphasized that no general rule can apply to all cases.
it often brings about a decrease in glycosuria and an Each case must be studied individually and only by such
increase in sugar tolerance, its chief effect is in lessen- stud cean the proper line of treatment for any particular
oin acidosis. It is to be given alone, i. e., with no other case be determined.
carbohydrate, and in amounts of 250 gm. a day.a7
Finally with regard to fat feeding, it is known that
alsthougli the acetone bodies are formed chiefly from fats, TaE ACTION' OF GLYCOL ALDEHYD AND
t hieir aniount is uninfluenced by the amount of fat iGLYCEIN ALDEYD N DIBETES MEL-
diet uless in enormo us quantities. The lower fatty ITS AD THE TUE
acids in butter should preferably be remov ed by washing.
Our knowledge concerning acidosis is as yet very in- ANTIKETOGENES IS *
complete. In a case in whlich complete sugar intolerance R. T. WOODYATT D.
eis present, acidosis mao be slight. In another with slight CHICAGOo
glycosuria the acidosis mtay be nmarked. Allardi has
pointed out th at il diabetic dogs the acidosis le not due It l generac ly known tt the acetone bodies n d(aetone,
glycosuria at ollce incIeasesI.is gnerally komani thrate-0hc the aessened boxdaies ofsuacsdetonte,ia
to a non-utilization of carbohydrate, but probably to aceto-acetic acid sud bete-oxybutyrie ecid) bave their
pathologic state of thle liver function. It seems estab- oiin butyri acid, wich tur coms fron the fats
lished thiat thie condition is not an acidosis in the strict d to a lsser extent from the proteins, sd that the
sfense, but rather an intoxication due to specific poisons. ain prerequisite for development of acidosis a dimi-
0 these one at lfast ae know-oxybntyric aeid-and nution l sugar oxidation. When for any reason the
we know too that its salt s are poisonous. Our efforts ail oidation of gar the body fall below a certain
treatnrient are directe d toward preveting the excessive inmum (say 50 to gm. par day for a man weiging
fnormation ur these sumou tanso es sud i hastedinug their 75 kilograms) then some degree of a cidosi s superven es.
aerretion. A strict protein diet increases the acetonuia the acidosis of starvation, which lowered ger
salt i~~~~~~~ ~~~~~n thvee acidlosis of mstar gventillleaount, in lwhicidsi arlkownaatieroedi sugsarcs
1but if it eau ha persisted l an ultimata decrease may combustion is the result of a diminished intake of carbo-
obiten bh ohtaied. So alas tlie addition of cerbohydrates drate food, the me re administration of sugar serves to
to the diet lessens markedly the acidosis, altog the stop the haccumulation of aetoue bodies. tu diabetes, il
17~~~~~~~~~~~~~~so the acutmulatisoin ofe acddeto;2ew eg nd ege bodes. Ilndiabo te tniers,itSOmONY l asistntoPrf le
glycosurie et once iner·eases. Wbarie coma le thraaten- which the lessened oxidation of sugar is due to te ina-
ing, the 0lvcosnria le of ciurse of lese importance than biltty on the part of the body to attack the glucose
tha diniinstion in acidosis. Tha introduiction of periode molecule, even when present in abundance, the adminis-
Thof vegetablle dsas, and of oat usal fed;ing lse espeai-lly tration of sugar has less effect than in other acidoses. But,
beneficial il persistent acidosis. The action of sodium though a diabti cannot oxidize glucose, ha may be able
bicarbonate is chiiefly that of increasing the excretion of to oxidize othar substances chemicelly allied thereto,
oxvhntvrici acidt, su-id nie îiust ont ha msled by thie pres- such as gluconic acid, saccharic acid, alcohol, etc., and
ence of larger amounts ou oxybutyrie acid lu the urine thus lower the exieting acidosis. Sugars sud elhied
tter its admiinistration. T'o get tlie hast effeets fmom hua substances wliich in oxidizing in the body have the power
salt in severe acidosie it nmust e given in large amounts, to lower acidosis are known as antiketogenie substances.
100 guri. or mor·e a da3y. Wb:her·e coma le present 1h eiosilet n Read in the joint meeting of the Section on Pharmacoogy asnd
bTherapeutics and the S ection on Pathology and Physiology, at the
he,given by intravenouls iîîjcction. Sixty-First Annual Session, held at St. Louis, June, 1910.
lii. Gigon: Miiuebefl. med. Webnscbix, 1555, ivi, 507. The original incentilve to do this work was received in Munich.
16. Gigon : Miinchen. reed. Wchnschr., 1909, lvi, 907.W hnwrigoteoxdinoflyrninhescdmdca
17. The oatmeal is given as gruel; 200-300 gm. butter is usually lenworbini1oclhe oxidation ao glycerin in bhe second medicah
taken also, and there may be added a few eggs and vegetables. am the giycerion aodebyd Oas prepared, wbicb,
18. Allard: Arch. f. exper. Pathi. u. Pharmakol., 1908, lix, 338. na fbe suggestion at Dr. Oua Neubaser, assisins ta Prof. F. Mliter,
19. The following v getables may be used; asparagus, cauli- w of te wo a diabeiic patieiiben under observation. Luier deveiup-
flower, string brans, Bressel sprouts, cabbage, sauerkraut. so)inach, i of ibe worb mas dont in Cbicaeo in lbe Mediess Depariment
irttuco, endives, olives. In addition 4 to 6 eggs are taben daily. ' ausb Medieni Coilege (Profinsor llingn).