A treatise on the principles and practice of medicine . onstituents.—Diabetics usually excrete 15 to 20 more of nitrogen daily (the normal being 10 to 15 gm.); the ureamay reach even 60 to 150 gm., (metabolism being increased 15 per cent,in severe types); larger figures are reached in no other disease; the con-dition is pathological when the amount of nitrogen in the urine exceedsthat in the food. Ammonium, normally or 1 gm. per diem, may increase to 3, 6 oreven 12 gm., and may constitute 10 to 20 per cent, of the total nitrogenoutput (instead of the normal 3 to 5 per cent.); over 5
A treatise on the principles and practice of medicine . onstituents.—Diabetics usually excrete 15 to 20 more of nitrogen daily (the normal being 10 to 15 gm.); the ureamay reach even 60 to 150 gm., (metabolism being increased 15 per cent,in severe types); larger figures are reached in no other disease; the con-dition is pathological when the amount of nitrogen in the urine exceedsthat in the food. Ammonium, normally or 1 gm. per diem, may increase to 3, 6 oreven 12 gm., and may constitute 10 to 20 per cent, of the total nitrogenoutput (instead of the normal 3 to 5 per cent.); over 5 gm. indicate asevere type, probably with death within a year, especially in subjectsover fifty years of age; the highest figures are seen exclusively in diabeticcoma. The organism excretes increased ammonia to neutralize may reach 1 or 2 gm. per diem. The uric acid is nearly normal. Acetonuria, or ketonuria, indicates the presence in the blood of j3-oxy-butyric and diacetic acids. This acidosis results from either (i) an PLATE XIX. Sfjflli Crystals of Phenyl-glueosazone. (Musser.)(Oc. 4, Obj. D.) Drawn by J. D. Z. Chase. DIABETES MELLITUS 729 entirely abnormal type of metabolism or (ii) intermediate substances,which the diseased organism cannot split up into normal end-products(water and C02), thus robbing the body of native alkali and decreasingthe power of the blood to take up C02. These acid sustances are derivedfrom the fatty acids and possibly from protein. (3-oxybutyric acid isabsent in diabetics in good physical condition and not infrequently alsoin those who are suffering from marked loss of albumin. The urineand breath may be odorless or may smell like chloroform, fruit or daily excretion varies from a few grams to 50 to even 100 to 180 abnormal excretion once begun, is uninterrupted and constantlytends to increase. It is of the gravest prognostic significance because inmost cases, at the end of days, weeks or months, fatal diabetic
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